ABSTRACT
This chapter is based on a talk given at the Tavistock and Portman as part of a psychotherapy training program. It is an exploration of the dynamics of shame in the wake of child sexual abuse. It primarily considers shame in therapeutic settings from a psychoanalytic perspective, using clinical examples to illustrate how this emotion is intimately related to child sexual abuse. It differentiates between shame and other related emotions and also invites the reader to consider their own responses to this universal emotional state. The chapter also explores theories of neglect and how shame is encoded early in life as an internalised response to a lack of responsiveness from caregivers. It introduces the theory of toxic shame and the impacts it has on help seeking and the therapeutic relationship, using examples from survivor literature to illustrate these dynamics. It concludes with some reflections on how clinicians can usefully support survivors in dealing with their shame.
