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University of Notre Dame Australia School of Arts and Sciences Counselling

SHAME: THE INGENIOUS QUILT A study of the relationship between shame and the presenting issues of those seeking therapy

Alistair P D Bain B.D. (Hons), Grad. Dip. Inf. & Lib. Studs., B.A. (Hons)

October 2011

CN606 Dissertation In partial fulfilment of the requirements for the award of Master of Counselling

University of Notre Dame Australia Fremantle campus

Shame: the ingenious quilt

Statement of Original Authorship I declare that this is my own work and that to the best of my knowledge and belief it contains no material previously published or written by another person except where acknowledged and cited.

Signed ………………………………………….. Alistair P D Bain

Date ………………………………


Shame: the ingenious quilt

Acknowledgements jIdw;n de; tou;" o[clou" ejsplagcnivsqh peri; aujtw'n o{ti h\san ejskulmevnoi kai; ejrrimmevnoi wJsei; provbata mh; e[conta poimevna.

TO the many who have been my shepherds, thank you:

The Rev’d Judith Peterkin, whose insights during the summer quarter of Clinical Pastoral Education at Royal Perth Hospital (1991-1992) first raised my interest in this fascinating topic.

The four therapists whose willingness to participate in this study provided not only the core data, but also an education in itself.

Dr Erica Usher, my Clinical Psychologist, whose own insights and therapeutic care during “the therapy hour” have been unquestionably beneficial, and a powerful example of “being held in the mind of an other”.

And finally, but no less significantly, thank you to the Counselling course staff of the University of Notre Dame, Australia, Fremantle campus, family members, and friends – the indispensible, and the sine qua non!


Shame: the ingenious quilt ABSTRACT Shame is commonly described in the literature as “painful”, which may account for the relative poverty of research into this affect, compared, for example, with anger or abuse. Part of the problem is that the terminology for the affect, shame, has yet to be conclusively settled, and debate continues as to whether shame is a distinct affect, or the extreme emotion in a continuum that might include embarrassment, shyness, and humiliation. In addition, a longstanding confusion between and conflation of shame and guilt exists. The research leans heavily towards a phenomenological, psychic and physiological distinction that empirical studies – both quantitative and qualitative – repeatedly confirm. Equally significant is the likely, almost inevitable, question of “disguise”. Shame notoriously lies, not merely dormant, but deliberately hidden. Exposure of perceived flaws is the greatest terror for the shamebased person. Nevertheless, shame may well be the underlying pathology in a range of presenting issues, especially abuse. This study seeks to examine some of those issues and to determine whether clinicians recognise or deem it appropriate to tackle shame itself, or alongside the presenting issues clients bring into therapy. Using the qualitative approach of interpretative phenomenological analysis (IPA), the research examines responses from four psychotherapists, all of whom recognise the presence of shame in their clients’ presentations. Although the therapists’ backgrounds and theoretical perspectives vary, the majority effectively use non-judgemental, non-shaming approaches with their clients, in other words, a person-centred approach that seeks to form a therapeutic relationship of trust and validation of emotion and experience. The significance of shame for further research, possible inclusion in coursework, and for clinicians lies in the under-researched nature of shame, its prevalence in all cultures and communities, and in the breadth and diversity of shame’s presentation in the therapeutic landscape.


Shame: the ingenious quilt


Statement of Original Authorship









Overview of topic



Context of topic



Emergence and importance of topic



Research questions






Shame and guilt



Healthy shame?








The literature in detail



Shame in overview



Shame and guilt



Shame, attachment and developmental theory



Shame and abuse



Shame: the ingenious quilt


Towards a summary and conclusion



Treatment and healing of shame



Concluding overview








Interpretive phenomenological analysis: theoretical underpinnings















The sample



The participants



The data collection instrument – interview schedule



Interview particulars



Sequence of analysis








Thematic narrative



Foundational issues



Shame theory



Presenting issues









Shame: the ingenious quilt






Information Sheet


Appendix B

Consent Form


Appendix C

Data collection instrument – interview schedule


LIST OF TABLES Table 1: Participants


Table 2: Themes and sub-themes



Shame: the ingenious quilt PART 1: 1.1


Overview of topic Those who write about shame commonly describe it as one of the most painful of human experiences (B. Brown, 2008; Kaufman, 1991; Middleton-Moz, 1990; Nathanson, 1987; Nathanson, 1992; Tangney & Deering, 2004; Tomkins, 1963). B. Brown (2008) further asserts that ―shame is universal – no one is exempt‖ (p. 3). In that context she suggests that even for mental health professionals the act itself of discussing shame with patients will invoke shame issues for those professionals (B. Brown, 2008).

The deliberately-ironic subtitle of the research project seeks to encapsulate, metaphorically, the complexity of this ―universal‖ (B. Brown, 2008, p. 3; Heller, 2003, p. 1018) affect whose manifestations are multi-faceted and sometimes contradictory or paradoxical (Nathanson, 1987; Middleton-Moz, 1990). Nathanson (1987) offered the academic community shame‘s ―many faces‖ and Middleton-Moz (1990) spoke of shame (and guilt) as ―the masters of disguise‖. It is shame‘s ability to manifest itself in numerous disguises, with many faces, that makes it ―ingenious‖. It resembles the quilt for similar reasons: a quilt is an amalgam of many elements of fabric, three layers deep. It is also a covering, just as shame seeks the covering of its multifarious disguises. The central irony is that unlike the usual connotation of ingenuity, shame‘s ingenious nature not only causes intense pain to the person bound within its fierce perimeter, but its quilt-like covering is deceptive and lacking authenticity: the shame-quilt appears to offer a person protection, but the costs are exorbitant and the quilt itself is extremely fragile rather than truly protective.


Shame: the ingenious quilt


Context of topic B. Brown‘s (2008) observation concerning the purported universality of shame notwithstanding, the specific context of this research project is the actual therapeutic environment. The underpinning assumption is that shame is pervasive and therefore likely to manifest itself in one or more guises when a person seeks therapy.

Within that context, the researcher wanted to test a second assumption: that therapists might not recognise shame as a critical issue for clients, focussing instead on arguably more obvious pathologies. As the findings suggest, this proved not to be the case, with all interview participants being able to recognise and articulate shame as a significant issue. The psychotherapists interviewed were also able to shift their focus in response to obvious shame manifestations.


Emergence and importance of topic The researcher first became interested in shame during a ten-week course of Clinical Pastoral Education (CPE) at Royal Perth Hospital, Western Australia, undertaken as a partial requirement for ordination as a priest in the Anglican Church. The clinical supervisor of the course observed underlying shame issues in many of the researcher‘s behaviours and reactions. The researcher‘s subsequent reading on the topic produced a prize-winning essay1, but more significantly explained much that had previously mystified and disturbed him.


The Sambell Prize (Australian Health and Welfare Chaplains’ Association).


Shame: the ingenious quilt The CPE course thus sensitised the researcher to instances and manifestations of shame during the course of his pastoral work within the Church, and in the wider community.

Within the academic sphere, the researcher notes that shame has received less attention than other affects, for example, anger, and is rarely the subject of dedicated, specific research. One of the pertinent issues is that it has proven difficult to create and undertake empirical research on shame. Nevertheless, some of the literature (see below) suggests that researchers are beginning to make attempts to study shame in a more systematic, evidence-seeking manner.

The relative poverty of research and the pervasive (arguably universal) nature of shame (Lewis, 1995; B. Brown, 2004) make this affect particularly significant for further study and research.


Research questions The research question that informs this project is

What is the relationship between shame and the presenting issues of those seeking therapy?

The researcher was interested in discovering some related, underlying issues: 

To what extent did psychotherapists recognise shame or shame-based behaviours in their clients?


How did psychotherapists distinguish between shame and guilt?


Shame: the ingenious quilt 

What methods did psychotherapists use in navigating the likely-to-be-fraught passages of shame?

To this end, the following questions served as the guiding basis for the semistructured interviews that ensued: 

What do you understand by ―shame‖? How common is it for clients to present with shame?

In your view, what is the difference between healthy shame and toxic shame?

To what extent do your clients recognise shame as a therapeutic issue for them? How is shame manifested by clients?

If you are treating a client‘s shame as a significant therapeutic issue, what strategies or therapies do you use?

How would your therapy approach differ if shame is a peripheral issue for clients? How would your approach differ from working with clients who are not shame-based?

In your experience, what are some of the ways clients try to mask or hide their shame?

What is it, in your view, that helps resolve issues of shame?

The questions themselves provided a skeleton that the researcher believed offered sufficient material for the psychotherapists interviewed to flesh out. This proved to be a justified belief. The therapists whom the researcher interviewed provided rich, example- and anecdote-laden responses that gave answers to these questions without them (necessarily) having to be asked specifically.


Terminology It is necessary to be clear about the use of the word shame because confusion exists both in the literature and in common use about what constitutes the affect, shame, to the extent that the word itself is used to describe what is more accurately referred to as


Shame: the ingenious quilt guilt (Middleton-Moz, 1990; Tangney & Dearing, 2004). As Tangney, Mashek, and Stuewig (2005, p. 44) observe: ―Much emotion research, especially research on the self-conscious emotions, hinges on self-report. Yet, in the domain of emotion, we can be easily misled by words.‖


Shame and guilt

It is possible to make a rough distinction between shame and guilt. Following Nicolosi (2009) the broad difference is that shame says, ―You are bad,‖ while guilt manifests as, ―You did something bad,‖ (p. 267). In other words, shame invades and inhabits a person‘s sense of being, while guilt associates itself with what a person has done.

Tangney and Dearing (2004, pp. 78-89) speak in terms of a person‘s capacity for empathy and ―other-orientation‖, suggesting that while any given guilt episode may enhance empathy and ―other-orientation‖, a shaming event will interfere with, reduce or negate empathic feelings. This is because the person who does something (that is) wrong is able to retain an understanding of how their actions affect an other. The person who feels shame, however, is self-absorbed, living with a quiet but terrifying desperation to remain hidden, and the terror of being uncovered, discovered to be a flawed and unworthy being: such a person is unable to understand their behaviour with reference to the other (Gilbert, 2003; Kurtz, 2007; Tangney & Dearing, 2004; Wright, Gudjonsson, & Young, 2008).


Shame: the ingenious quilt 1.5.2

Healthy shame?

Some shame theorists and thinkers have suggested that a difference exists between healthy and toxic shame, arguing that healthy shame not only exists, but is a legitimate organising principle in society, as well as a moral guidepost (Bradshaw, 1987; de Hooge, Zeelenberg, & Breugelmans, 2010; Fossum & Mason, 1986; Stiles, 2008; Ryan, 2008).

Stiles (2008), for instance, argues that shame can act as motivational force and ―help social cohesion‖ (p. 1). In a similar vein, de Hooge, Zeelenberg, and Breugelmans (2010) argue that shame can motivate what they call ―approach tendencies‖ (p. 111). By this, they mean ―approach‖ with a view to making amends for wrong-doing (ibid.). Ryan (2008), under the heading ―Shame is integral to healthy human functioning both personal and social‖, compares shame with anger and fear, suggesting that ―there are some things we should be ashamed of‖ (pp. 9-10). Such a proposition would certainly resonate with proponents of ―naming and shaming‖.

The researcher was initially of the opinion that toxic shame certainly occurred as a pathological condition requiring healing, and in principle accepted that therefore the obverse (healthy shame) theoretically had to be considered alongside its notional affect-sibling.

However, he is now persuaded that any notion of shame being ―healthy‖ is mistaken, and returns to the issue of terminology, confusion and the misleading and incorrect conflation of shame and guilt.


Shame: the ingenious quilt The researcher notes that de Hooge, Zeelenberg, and Breugelmans (2010), Stiles (2008), and Ryan (2008) all put their case using the language of guilt. Ryan (2008), for instance, speaks with approbation of ―shame/regret‖ (p. 15), apparently regarding shame and regret as synonymous. However, a person ―regrets‖ doing or not doing something: it is a guilt concept (Lewis, 1995). Similarly with the arguments of de Hooge, Zeelenberg, and Breugelmans (2010), and Stiles (2008). This is before even considering the morally-repugnant notion of manipulation that masquerades as ―motivation‖ (Fossum & Mason, 1986; Stiles, 2008).

B. Brown (2005) argues persuasively for regarding shame as shame, by definition toxic and never able to be pressed into the service of personal, social or corporate control. In her critique of the Joyce Brothers opinion piece, ―Shame may not be so bad after all‖, Brown argues that

promoting good shame is like saying there‘s ―good starvation‖ and ―bad starvation‖ and that we need to address the obesity epidemic with ―good starvation.‖ Just like there‘s no such thing as ―good starvation,‖ there‘s no such thing as ―good shame.‖ The “good shame” that she describes in her article is actually a combination of guilt and empathy (emphasis added).

Holloway (2005) quotes another prolifically-published shame researcher, June Tangney, as saying, "Shame is not useful or protective. Guilt is moderately preventive" (p. 22). Tangney (in Holloway, ibid.), having conducted appropriate empirical research, goes on to say, contrasting shame and guilt as social responses to


Shame: the ingenious quilt combating crime, ―We know that treatment works in some way. Punishment doesn't work.‖

Accordingly, when the researcher uses word shame in this study, it carries no positive connotation, it is not regarded as ―healthy‖, but rather is seen as a debilitating and pathological affect, for which, nevertheless, hope for treatment and healing continues to exist.


Shame: the ingenious quilt PART 2: 2.1


Introduction The literature on shame is varied, though broad seams of interest and concern run through it. Expected topics, within the context of shame, include general discussions and overviews; eating disorders and related body-image issues; sexual abuse and abuse within the breadth of that spectrum; and developmental and attachment issues. Not surprisingly, a considerable intersection, overlap and interaction occurs between some of these common themes and concerns.

Another significant body of exploration takes in notions of healing shame, with differing perspectives discussed, assessed or proposed.

Among topics the researcher found less predictable were discussions of the connection between shame, spirituality and ecclesial institutions2; development of empirical or evidence-based tools for measuring or evaluating shame; and broadlydefined ―cultural‖ studies of shame, which included comparisons between nationalities, student bodies, sports teams, and organisations. The literature also includes a small number of studies exploring shame from an evolutionary perspective.

Although many articles dealt with shame in a psychotherapeutic setting, none directly addressed the research question. The researcher did not find this altogether surprising: the literature tended to focus on particular issues (as above), rather than a particular therapeutic environment.


The subject itself is unsurprising, given the historical propensity of the Church to use shame and guilt brazenly as mechanisms of control and weapons of mass degradation.


Shame: the ingenious quilt The majority of the literature referenced contained a wealth of empirical data. The researcher believes that any study of shame and its presentation in therapy would demand an evidence-based approach because although psychotherapeutic practice unquestionably has its theoretical underpinnings, whether they be specificallyfocussed (such as CBT or Gestalt), or eclectic, actual praxis necessarily operates beyond or above those underpinnings. Much of the literature reflected this belief and involved evidence-gathering as the basis for their studies.


The literature in detail 2.2.1

Shame in overview

The winter 2003 edition of the journal Social Research focussed entirely on the ―phenomenon of shame‖, to borrow from the title of Agnes Heller‘s (2003, p. 1015) overview article, Five approaches to the phenomenon of shame. Heller dealt with shame from the point of view of the disciplines of anthropology, sociology, ethics, psychology and history. Although her article contains much that is intellectually engaging, her approach is deliberately philosophical (ibid.), even when she examines the ―psychological approach‖ to shame (pp. 1024-1027).

Nevertheless, her overview, taken together, highlights several of the confounding issues of terminology and definition examined in Part 1 of this dissertation. For instance, Heller (2003, p. 1019) conflates guilt and shame in the following discussion of the sociological approach:

The bearer of the social triggers of shame is the eye of the Other, the eye of the community. One is constantly seen whatever one is doing; one is supposed


Shame: the ingenious quilt to be seen. If she carries out all activities according to norms or rules of the community, she is not ashamed for the Eye approves. However, if she is doing something that infringes the rules, or at least might be seen as something that infringes them, the affect of shame conquers or possesses the person. Whenever the eye of the Other disapproves, the guilty party feels annihilated: she blushes, bends her head so she cannot see the judgment of the Eye, runs away or at least feels the urge to disappear or sink into the earth in order not to be seen. Are you not ashamed? You should be ashamed! You must be ashamed! Shame on you! chides the adult world to the child who tries not be ashamed but rather to learn when and where to avoid shame.

Shame, however, involves a person‘s being (Gilbert, 2003; Kurtz, 2007; Nicolosi, 2009; Tangney & Dearing, 2004). The ―bearer of the social triggers of shame‖ (Heller, 2003, p.1019) is the person, not the community. Further, it is not the ―guilty party‖ who feels ―annihilated‖ (Heller, ibid.) but rather the shamed or shame-based (Bradshaw, 1988) person who will almost certainly feel the annihilation, the bodily manifestations of shame such as blushing and the avoidant gaze, and the imagination‘s metaphor of ―sink[ing] into the earth in order not to be seen‖ (Heller, 2003, p. 1019).

The confounding pronouncement of judgement using the statements Heller quotes – Are you not ashamed? You should be ashamed! You must be ashamed! Shame on you! – typically occur in the context of guilt; that is, when a person has done something (morally) wrong or bad. Consider, for example, the recent case of a Royal Australian Navy sailor convicted of raping a female colleague while she was sleeping


Shame: the ingenious quilt (Draper, 2011). The Victorian County Court Judge, Michael Tinney, made the following comments:

"You did as you pleased with her," Judge Tinney said. He said Calvert held his phone in one hand while penetrating the 18-year-old with the other, treating her "as no more than an object or a prop". "This was disgraceful conduct by you, both in penetrating her in those circumstances and filming it, and became more disgraceful still when you showed this material to other men," Judge Tinney said. "You should be ashamed of yourself."

The judge‘s comment, even though it uses a derivative of the word shame, arises from a judgement of guilt, in other words, something done. Ironically in this case, it is possible that the assailant, ―who had been a loner growing up, [and] was attracted to the camaraderie promoted by the defence forces and had joined the navy to make friends‖ (Draper, ibid.) may well have shame issues that occurred in childhood (Boyd, 2007). If this suspicion proved true, the judge‘s remark, ―You should be ashamed of yourself,‖ is redundant: the assailant would already be shame-based and that could be one of the primary psychological factors informing his treatment of a powerless woman.

Since shame and guilt exercised several researchers, this issue is examined next.


Shame: the ingenious quilt 2.2.2

Shame and guilt

As noted in Part 1 and in the previous section (2.2.1), confusion exists between the concepts of shame and guilt. At one level it is a problem of language and its limitations. Sabini and Silver (2005, p. 1) highlight this issue in their Target Article and argue that:

linkages between mental states and emotion terms are more complex than emotion theorists have thought…[and] there are fewer mental states than there might seem to be, but…they are related to language and its use in more complicated ways than had been thought.

In other words, in English, for example, the number of words available to describe emotion or affect exceeds the number of actual emotions (cf B. Brown, 2008, p. 12; Tangney, Mashek, and Stuewig, 2005, p. 44).

Sabini and Silver (2005, p. 7) argue that ―shame and guilt are not in general the same, though they may in particular instances be the same‖ (their emphasis). However, Tangney, Mashek, and Stuewig (2005, p. 46) conclude that shame, guilt and embarrassment are distinct, at least to the extent that the ―semantics of emotion seem to capture meaningful variations along multiple relevant dimensions‖. They reach their conclusion after referencing a wide and complex range of empirical studies (Tangney, Mashek, and Stuewig, 2005, p. 45). Other studies support the view that these distinctions are empirically verifiable and valid (B. Brown, 2008, p. 13; Tangney & Dearing, 2004, p. 49; and Tangney, Miller, Flicker, & Barlow, 1996, p. 1267).


Shame: the ingenious quilt

A question arises, however, about the phenomenological aspects of these differences (Tangney, Wagner, Hill-Barlow, Marschall, & Gramzow, 1996). Researchers and theorists typically regard shame as a disorder of the self (Lewis, 1995; 2003; Morrison, 1987; Reid, Harper, & Anderson, 2009; Tangney, 1991; Tangney, Wagner, Hill-Barlow, Marschall, & Gramzow, 1996; Tomkins, 1963). This understanding reflects the greater attention paid to the study of shame, and its differentiation from guilt, since the first half of the twentieth century: empirical research has demonstrated that the then-nascent public (shame) versus private (guilt) dichotomy was unhelpful, inadequate and misleading (Miller, Flicker, & Barlow, 1996; Tangney & Dearing, 2004)).

Shame is commonly described as ―painful‖ (B. Brown, 2008; Felblinger, 2008; Nathanson, 1987), meaning that when a person experiences a shaming event, whether deliberately-targeted at the person, or perceived as such, the shame affect activates both a physiological and psychic response (Cozolino, 2002; Sabini & Silver, 2005). The descriptive vocabulary of these phenomena is often intense. Terms used include ―annihilated‖ (Heller, 2003, p. 1019; Sorotzkin, 1985), ―excruciating‖ (B. Brown, 2008, p. 5; Felblinger, 2008, p. 237; Kaufman, 1992, p. 9), ―emotionally overwhelming‖ (B. Brown, 2008, p. 5). Silvan Tomkins (1963, p. 118) had already discussed the phenomenology of shame using these powerful words: ―…shame is felt as an inner torment, a sickness of the soul…[the shamed person] feels himself naked, defeated, alienated, lacking in dignity or worth.‖


Shame: the ingenious quilt That this language is so clearly metaphorical suggests several issues: the intensity of the shame experience is such that only hyperbolic word pictures can approach an adequate description of its effect on a person; although research supports the viewpoints, the descriptors remain at the theoretical level; metaphorical language itself implies the hiding, covering, avoidance of exposure that is so markedly a feature of shame. As B. Brown (2010) states, discussing shame during a TEDxHouston Talk, ―No one wants to talk about it, and the less you talk about it, the more you have it.‖ The limitations of Brown‘s twenty-minute public lecture account for the succinctness of the comment but it reiterates the fully-formed and –researched material in her earlier work (2008), while other research and theory supports the same view (Hansen, 2006; Kaufman, 1992).

Lewis (1995, p. 34) provided a four-point summary of phenomenological issues. First, shame exists prior to its inevitably-sudden emergence as a result of the right stimulus. That is to say, shame will already be internalised in a person without their necessarily (initially, or pre-therapy) being aware of it, but certain triggers will activate the affect so that it becomes a feeling, which is how the person will experience the shame. Wanting to hide, disappear or, in the classically-expressed vernacular, have the ―ground open up and swallow me‖, is the common clue that a person has experienced a shaming event or trigger. (Heller, 2003; Nathanson, 1987; Nathanson, 1992). Second, as seen above, shame brings with it an extreme level of discomfort. Lewis contends that this intensity distinguishes shame from embarrassment and shyness (Kaufman, 1992; Tangney, Miller, Flicker, & Barlow, 1996). Third, the implication of the affect, shame, is a generalised sense of defectiveness (B. Brown, 2008; Tomkins, 1963; Young & Klosko, 1994). Fourth, in shame the person becomes both subject and


Shame: the ingenious quilt object, the result of the person being and becoming thoroughly self-focussed (Kaufman, 1992; Nathanson, 1987; Tomkins, 1963). This suggests one of the reasons for the shame-based person‘s absence of empathy: they lack the necessary awareness of the ―other‖ (the object) because of this thoroughgoing focus on the self (B. Brown, 2008; Tangney & Dearing, 2004).

However, one of the singular features of shame is its physiological manifestations, arguably the most recognisable of which is blushing (Cozolino, 2006; Hansen, 2006; Heller, 2003; Nathanson, 1987). Other typical indicators of the activation of shame include variations on avoidance: lowering the head, downcast eyes, covering head and eyes with a hand as if shielding them from the glare of the sun, ―burying‖ the head in both hands (Cozolino, 2006; Heller, 2003; Potter-Efron & Potter-Efron, 1989; Tangney, Mashek, & Stuewig, 2005). Tangney, Miller, Flicker, and Barlow (1996) also reported heart-rate increases in test subjects who felt shamed.

However, if the affect, shame, gives rise to powerful feelings, and if activated shame has a physiological expression, how does shame ultimately appear? what actions might result from a ―shame attack‖ (B. Brown, 2008)? Reid, Harper, & Anderson (2009) used a version of Nathanson‘s (1992) Compass of Shame Scale (CoSS), which Elison, Lennon and Pulos (2006), and Elison, Pulos and Lennon (2006) had modified to account for the ―source of the shaming event‖ (Reid et al, 2009, p. 128). The CoSS attempts to describe broadly the four ―action tendencies‖ (ibid.) of a shamed person. In other words, these four ―poles‖ (ibid.) of the Compass suggest likely behaviours when a person experiences shame.


Shame: the ingenious quilt The first pole is Withdrawal, which, as its designation implies, reflects a shamebased person‘s tendency to withdraw from confrontation in order to defuse a shaming event perceived as negative and valid (ibid.). The second pole is Attack Self. Here, anger is apparent, but directed towards the self, the purpose being to encourage support from others ―by engaging in self-deprecating comments‖ (ibid.). Attack Other is the third pole, within which the shamed person‘s anger is aimed outwardly in order to lessen or remove the pain of feeling shamed. This ―externalisation‖ of shame often presents as blame, and can include ―rage and verbal or physical abuse towards others‖ (ibid.). The fourth and final pole, Avoidance, is akin to denial. The shame is neither admitted nor regarded as valid: the person ―attempts to distract, dissociate or disconnect the self and others from the painful emotion‖ (ibid.). The theory suggests that the shamed person, using strategies such as ―humour or indifference‖, is unconscious of their behaviour (Reid et al, 2009, pp. 128-129).


Shame, attachment and developmental theory

Shame theorists are in large measure agreed that one of the significant sources of internalised shame comes from a person‘s earliest experiences of life (Bowler, 1997; Boyd, 2007; Cozolino, 2006; Erikson, 1995; Felblinger, 2008; Nicolosi, 2009). Cozolino (2006, p. 234) observes that the internalisation of shame occurs at a stage of life when a person – an infant – is unable to distinguish between ―the action and the self‖. In other words, the infant experiencing what, from an evolutionary perspective is the primitive emotion of shame, cannot understand that the shaming action of a parent or caregiver arises from the infant‘s behaviour, which the caregiver knows is separate from the infant. As far as the infant is concerned, they and the behaviour that incurs the shaming event are indistinguishable. This is where the quilt of shame


Shame: the ingenious quilt begins; the undivided landscape of infancy is the cutting table upon which shame is fashioned.

Inevitably, the literature either alludes or refers directly to the work of Erikson, who formulated an eight-stage developmental theory that sought to account for a person‘s psychosocial growth from birth to advanced age (Erikson, 1995; Yahaya, 2006) – though in Erikson‘s time life expectancy averages were lower than today‘s. Two stages are of particular importance for shame theorists: the second, early childhood, 18 months to 3 years; and the third, the play age, 3 to 5 years (Harder, 2009; Yahaya, 2006, p. 5).

The second stage – notoriously the age of toilet-training (Harder, 2009) – produces the psychosocial ―crisis‖ of autonomy versus shame and doubt (Yahaya, 2006, p. 6). This is the stage during which an infant‘s task is to separate from their mother and begin exploring their world independently . However, it is also a time of considerable vulnerability for the infant (Harder, 2009). If parents and caretakers encourage this exploration the infant will successfully complete the task of gaining autonomy. However, should parents or caretakers be routinely over-critical or ridicule the infant‘s attempts at being independent then the infant will feel shamed, and come to doubt their abilities (Miller, 1987; Yahaya, 2006). Conversely, caretakers‘ refusal to allow the infant to do anything for themselves will likely create the impression that they lack confidence in the infant‘s abilities, and again shame will be the result (Yahaya, 2006).


Shame: the ingenious quilt Stage 3, the play age, carries the label initiative versus guilt (Erikson, 1995; Harder, 2009; Yahaya, 2006, p. 7). This is the time the child begins experimenting and pretending, using their imagination to explore their understanding of the adult world (Harder, 2009) and, to use Yahaya‘s (2006, p. 7) delightful and insightful observation of the child‘s newly-developing capacity to imagine the future, to ―attempt to make that non-reality a reality‖. The locus of operation has also widened from parents or caretakers to include other members of the basic family unit (Harder, 2009; Yahaya, 2006). Yahaya (2006) and Harder (2009) both note that Erikson was a Freudian, even though he focussed more on psychosocial than sexual features. Nevertheless, Erikson did comment on the Oedipal nature of this stage: an element of conflict arises between the child and their parents, resolved when the child begins to understand and identify with their social role (Erikson, 1995; Harder, 2009). Should the parents handle this task in a harsh or overbearing manner the child will experience guilt (Harder, 2009; Yahaya, 2006, p. 8). In terms of the debate about shame and guilt, by this stage the child has separated from the parents and is able to understand their ―transgressions‖ as ―something done‖ rather than as something essentially flawed in their self.

Bowlby (2005) developed a theory of attachment that intersects at many points with developmental theory (Mills, 2005). According to Mills, he stands in line with object relations/attachment theorists who have produced a large and influential body of work on shame: Nathanson, Kaufman, and Schore (ibid.). For instance, Bowlby (2005, pp. 19-20) writes about the affect of parents‘ reactions to a child negotiating what Erikson, following Freud, would recognise as an Oedipal conflict:


Shame: the ingenious quilt Nothing helps a child more than being able to express hostile and jealous feelings candidly, directly, and spontaneously, and there is no parental task more valuable, I believe, than being able to accept with equanimity such expressions of filial piety as ‗I hate you, mummy‘ or ‗Daddy you‘re a beast‘. By putting up with these outbursts we show that we are not afraid of hatred and that we are confident it can be controlled; moreover, we provide for the child the tolerant atmosphere in which self-control can grow.

Bowlby (2005, p. 20) goes on to discuss the likely outcomes of two common parental responses that do not mirror this self-control: first, punishment as a means of behaviour-change and disapproval; and second, shaming, which Bowlby believes leads to guilt, anxiety and neuroticism in older children and adults. Both responses result in fear and guilt, and the repression of the child‘s feelings (ibid.). The researcher believes, however, that if parents can shame their child with statements ―impressing on the child his ingratitude, and indicating the pain, physical and moral, which his behaviour causes his devoted parents‖ (ibid.; emphases added) then it is likely that the child has already internalised shame, and these accusations of ingratitude and pain simply reinforce the child‘s belief that they are a fundamentally ―bad‖ person. In other words, what Bowlby isolates here are shaming statements (which he recognises) rather than observations of a child‘s ―guilty‖ behaviour. However, when Bowlby was writing – his monograph trilogy, Attachment and loss, appeared between 1969 and 1980, and he had published in academic journals prior to this (Sable, 2004) – serious study of shame was limited, shame and guilt were


Shame: the ingenious quilt considered more or less synonymous (B. Brown, 2008; Lickel, Schmader, Curtis, Scarnier, & Ames, 2005; Potter-Efron & Potter-Efron, 1989), and distinctions, when they did occur, were rudimentary, lacking in sophistication and not fully researched (Tangney, Miller, Flicker, & Barlow, 1996).

What makes attachment and developmental theory important for shame research is the clinical and research evidence that suggests that a person‘s early-life encounters have a lasting impact on their subsequent development and in their adult lives and relationships (Bowlby, 2005; Engel, 2006; Hansen, B., 2006; Marmarosh, Whipple, Schettler, Pinhas, Wolf, & Sayit, 2009). Marmarosh, Whipple, Schettler, Pinhas, Wolf, and Sayit (2009, p. 256) review Bowlby‘s concept of internal working models and his ―secure base‖ theory (ibid.). This ―secure base‖, representing parents or caregivers, is a reliable place to which the child, separating from these caregivers to explore their environment, can return, knowing that they will be safe (ibid.). Bowlby is under no doubts about the working model concept: ―The extent to which such working models are valid products of a child‘s actual experience over the years or are distorted versions of such experience is a matter of the greatest importance‖ (Bowlby, 2005, p. 140; emphasis added).

It is not surprising, then, that the literature includes several studies of shame and its interrelatedness to and with attachment theory. Wei, Shaffer, Young, and Zakalik (2005, p. 591) produced a study of the relationship between attachment anxiety and attachment avoidance, on the one hand, and shame, depression and loneliness (psychological distress), on the other. Using a sample of 299 undergraduates, they factored ―basic‖ psychological needs satisfaction (autonomy, competence and


Shame: the ingenious quilt relatedness) into their comparisons between attachment style and significance of distress (Wei et al., 2005, p. 592). They found that attachment avoidance was not significantly related statistically to shame, depression and loneliness (Wei et al., 2005, p. 598). However, they did find a significant statistical relationship between the distressors and attachment anxiety (ibid.). In describing this outcome, they use the recognisable language of shame (ibid.):

Individuals with high levels of attachment anxiety tend to have a negative working model of self and are more likely to suppress or be unaware of their basic psychological needs because they have learned that these needs are part of what makes them unlovable. [Emphases added.]

Attachment theory suggests that this is because a person with attachment anxiety has a negative self-image and a negative view of others (Cozolino, 2006; Wei et al., 2005). By contrast, the person whose attachment style is avoidant has a positive view of self and a negative view of others (Cozolino, 2006; Wei et al., 2005). A person‘s self-image is the key where shame is under consideration (Lewis, 1995; 2003).

In 2003 Sohlberg, Claesson and Birgegard, using a controlled experiment that tested the effect on subjects of the subliminal message ―Mommy and I are one‖ (Mommy), reported findings that reiterated attachment theory, stating that the ―data are clearly compatible with a link between early relationships and adult functioning‖ (p. 344). Besides the Mommy phrase, they used an intended shaming phrase ―I am completely isolated‖ (Isolated) alongside a neutral control ―People are walking‖ (People), and


Shame: the ingenious quilt then measured subjects‘ responses (Sohlberg, Claesson, & Birgegard, 2003, p. 339). Of interest to this research project was the finding that the two control phrases produced similar results: the intended shaming phrase, Isolated, did not give rise to remarkably different scores from the neutral People phrase, with the result that the control group effectively doubled in relationship to the Mommy group (Sohlberg et al., 2003, p. 344). Where high shame scores did result was within the Mommy group, in instances where subjects had a poor relationship with their mothers when they were children (ibid.). This again is consistent with attachment theory (Sohlberg et al., 2003, pp. 344-345), and shame theory (Engel, 2006; Hansen, 2006; Kaufman, 1992; Nathanson, 1987).

Similar results were apparent in a longitudinal study Mills, Arbeau, Lall and De Jaeger (2010) conducted with children initially aged 3 to 4 years, then again at 5 to 7 years, and finally at 7 to 9 years (p. 500). Their findings suggested that both mothers‘ and fathers‘ shaming behaviours were likely to affect the shame-proneness of their children, and that it was possible to predict with high accuracy the likelihood of shame-proneness when these children entered the school system (Mills et al., 2010, p. 522). The study also demonstrated gender differences (Mills et al., 2010, p. 521; cf Osherson & Krugman, 1990). In girls, high mother-shaming behaviour but low fathershaming produced greater shame-proneness (Mills et al., 2010, pp. 521-522). However, where both parents were high-shaming, girls tended to exhibit a lower proneness to shame (Mills et al., 2010, p. 522). The researchers concluded that girls‘ low shame response encouraged both parents to ―use more shaming‖ (ibid.).


Shame: the ingenious quilt However, preschool boys who returned shame responses had shaming fathers, but by school age boys‘ proneness to shame was associated with high mother shaming behaviour, though mothers‘ behaviours may be a result of perceiving their sons‘ higher levels of behavioural inhibition as a weakness to be eradicated (ibid.). The research concluded that ―proneness to shame is associated with a wide range of psychological symptoms by middle childhood and potentially earlier‖ (Mills et al., 2010, pp.522-523), suggesting that ―further longitudinal investigation is warranted‖ (Mills et al., 2010, p.523).

Although this study (above) neither mentions nor alludes to attachment theory, the evidence of parental shaming behaviours as a control mechanism, leading subsequently to shame-proneness from a developmentally early age (Mills et al., 2010), supports the kind of ―attachment loss‖ (Bowlby, 2005) that is so much a part of the shame quilt (Bradshaw, 1988; Engel, 2006; Kaufman, 1992; Nicolosi, 2009; Potter-Efron & Potter-Efron, 1989).

The parental role was also examined in a study Scarnier, Schmader and Lickel (2009) undertook with the aim of comparing parent reactions to first, an actual instance of their child‘s ―worst transgression‖, and second, a fictional ―wrongdoing‖, in which the presence or absence of an observer acted as a mediating influence (Scarnier, Schmader, & Lickel, 2009, p. 205). The results were consistence with shame theory (B. Brown, 2008; Fossum & Mason, 1986; Kaufman, 1992; Nathanson, 1987). When parents perceived that their child‘s behaviour exposed them (the parents) to the public gaze, their shame ratings were high (Scarnier et al., 2009, p. 212). Parents‘ anger and distancing reactions were also more highly-correlated with the high shame scores,


Shame: the ingenious quilt again agreeing with previous research, especially that which suggested a strong relationship between shame and overtly-expressed hostility (Scarnier et al., 2009, p. 218). However, when parents believed that they had little or no control over their child‘s behaviour, guilt rated more highly (ibid.). The dénouements of the behaviourreaction studies also supported predicted outcomes: high-guilt parent ratings eventuated in adaptive strategies to attend to the child‘s behaviour; but parents whose reaction was shame-based or shame-prone exhibited maladaptive strategies, including harsher punishments meted out to their children, such as physically violent actions and withdrawal of parental affection (Scarnier et al., 2009, pp. 217-218).

This is an important study because it demonstrates possible links between shameproneness in children and their parents. It would be useful to study – especially longitudinally – the shame-proneness of children with high-shame parents: theoretical principles suggest that one of the underlying causes of shame in a person is the experience they have in their family of origin (Fossum & Mason, 1986; Hansen, 2006; Miller, 1987).

Scarnier et al. (2009) speak of maladaptive parent behaviours as a reaction to feeling shamed. Their assessment is an objectified description of what many would designate abuse, which is also one of the high-risk indicators for shame-proneness and shamebased behaviours (Bradshaw, 1988; B. Brown, 2008; Miller, 1987).


Shame and abuse

The word abuse is something of a loaded term; some evidence suggests a cautious approach to its use, particularly with regard to non-physical contact (NPC) abuse


Shame: the ingenious quilt (MacKinnon, 2008, p. 1). However, in her stakeholder paper for the Australian Domestic & Family Violence Clearinghouse, MacKinnon (2008, p.2) argues that NPC abuse ―works insidiously‖, is part of the phenomenology of physical and sexual abuse, is especially prevalent in ―most forms of child abuse‖, and has ―long-term‖ consequences at least as severe as ―long-term…physical abuse‖.

MacKinnon (2008, pp. 4-8) outlines three major areas in which the effects of childhood NPC abuse can appear in adults: physical health, mental health, and relationships. However, the experience of NPC and physical/sexual abuse not surprisingly has damaging effects for the child (MacKinnon, 2008). MacKinnon (2008, p. 4) summarises her literature review findings, stating that:

children who are exposed to domestic violence had more health problems, higher levels of depression, more attention difficulties, higher rates of internalising and externalising behavioural problems and less social and cognitive competence than children who were exposed [to domestic violence]

And one of the major consequences of abuse is a prevailing sense of shame (MacKinnon, 2008). MacKinnon goes on to observe that ―for many, shame is the most pervasive and debilitating dimension of their lives as adults‖ (2008, p. 6). Interestingly, she also mentions alexithymia, variously defined as ―the inability to identify one‘s own feelings‖ (ibid.), ―an inability to experience and communicate feelings consciously‖ (Mosby‘s medical dictionary, 2009), an ―inability to recognize or describe one's emotions‖ (Miller-Keane encyclopedia of medicine, nursing and allied health, 2003). Although he does not use the word alexithymia, Nathanson


Shame: the ingenious quilt (1992) describes a case in which his patient clearly displays alexithymic difficulties. Nathanson comments: ―The very deadness that characterized Casey‘s verbal output was a clue to the presence of shame…If you wonder why someone lacks vitality, look first for nearness to shame‖ (1992, p. 155; emphases added).

However, abuse need not necessarily occur in childhood, nor be prolonged: it may eventuate as a result of one or a few highly-traumatic incidents, such as rape (Herman, 1992). Whether abuse is a single incident or prolonged over many years, one of the possible, even likely, outcomes is post-traumatic stress disorder (PTSD) (Harman & Lee, 2010). In their consideration of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), Harman and Lee (2010) argue for a broadening of the DSM-IV-TR criteria for PTSD, which incorporates ―fear, helplessness and horror‖ (Harman & Lee, 2010, pp. 13-14) as the standard determinants. They say that people experiencing PTSD report a wider range of feelings than fear, helplessness and horror, among them being shame (Harman & Lee, 2010). Their subsequent study supports, to a large extent, their predicted view that shame and PTSD are substantially related (Harman & Lee, 2010, p. 21). Herman (1992, pp. 118-119) also called for ―a new concept‖, on the grounds that the definition of PTSD depended on particular trauma-inducing events, notably war and disaster, but failed adequately to describe the multiplicity of effects of prolonged abuse.

Nevertheless, Herman (2007) observed, ―shame can be likened to fear in many respects‖ (p. 5), and the phenomenology of shame is such that the shame-based person is constantly, however unconsciously, enmeshed in a terrifying world in which they seek to avoid exposure, the gaze of the other, the revelation of their flawed self


Shame: the ingenious quilt (Bradshaw, 1988; Heller, 2003; Lewis, 1995, 2003; Tomkins, 1963). This may be fear ―after the fact‖ and might be distinguished from fear at the time of a traumatic event, but from both an evolutionary and neurobiological perspective, primitive survival instincts are likely the activating principle in both kinds of fear (Badenoch, 2008; Cozolino, 2006).

As MacKinnon (2008) noted, with regard to non-physical contact abuse, the longterm consequences are likely to affect adult lives and relationships. Unsurprisingly, this is no less true where the abuse is sexual and/or physical, with several studies examining the relationship between shame and sexual/physical abuse (J. Brown, 2004; Buchbinder & Eisikovits, 2003; Farber, Khurgin-Bott, & Feldman, 2009; Feiring, Simon, & Cleland, 2009; Feiring & Taska, 2005; Rahm, Renck, & Ringsberg, 2006; Valerio & Lepper, 2009). Common themes, apart from shame, are evident in the research: symptoms of PTSD; relationship and sexual issues; silence and silencing; objectification; self-blame. However, even these pathologies are symptomatic of the larger shame canvas (Bradshaw, 1988; Engel, 2006; Hansen, 2006; Kaufman, 1992; Potter-Efron & Potter-Efron, 1989). The other unifying factor was that all the studies involved women survivors of childhood sexual abuse (CSA).

One study, however, focussed on male sexual abuse survivors (Lisak, 1994). Many of the men‘s consequential psychic injuries mirrored those of the various samples of women survivors: anger, fear, helplessness, isolation, legitimacy, loss, negative selfimage, sexual problems, shame and humiliation, and trust issues (Lisak, 1994, pp. 530-544). One notable difference, however, was the extent to which sexual abuse caused the men to question their sexuality, to ask whether they had homosexual


Shame: the ingenious quilt tendencies, and to raise more generalised issues of masculinity (Lisak, 1994, pp. 534539).

Another consequence of physical and sexual abuse is shame associated with body image in general and eating disorders in particular (Bradshaw, 1988; Engel, 2006; Fossum & Mason, 1986; Herman, 1992). Although a number of studies examined shame and eating disorders (Choma, Shove, Busseri, Sadava & Hosker, 2009; Keith, Gillanders, & Simpson, 2009; Schooler, Ward, Merriwether, & Caruthers, 2005; Siebold, 2008; Skårderud, 2007), only Skårderud (2007) examined the link with sexual abuse. Choma et al. (2009), Sadava and Hosker (2009), Keith et al. (2009) and Schooler et al. (2005) saw shame as related existentially to over-eating, anorexic tendencies, or body-image, but only Keith et al. (2009, p. 325) suggested that ―this shame is of a more general nature than simply shame about eating disturbance‖.

Nevertheless, eating disorders are only one of a number of maladaptive responses to shame and abuse (Engel, 2006; Kaufman, 1992; Skårderud, 2007). The acronyms FEARS and BAD FEARS (Goodwin et al., 1992, p. 221) succinctly, though perhaps not exclusively, describes a whole complex of intricately-related symptoms: ―Borderline disorders, Affective disorders, Dissociative symptoms, Fears (anxiety and other post-traumatic symptoms), Eating disorders, Alcoholism or other substance abuse, Revictimizations, Somatization disorders and Suicidality usually with compulsive self-mutilation‖. This was later modified to: ―Borderline, Affective, and Dissociative disorders; and…Fears and post-traumatic anxiety, Eating problems, Addictions, Revictimization, and Somatization‖ (Wills & Goodwin, 1996, p. 104).


Shame: the ingenious quilt 2.3

Towards a summary and conclusion As part of its process of discussion and conclusion, the literature almost invariably points towards ―implications for intervention‖ (Schilling et al., 2007, p. 121), ―implications for practice‖ (MacKinnon, 2008, p. 18), ―clinical implications‖ (Claesson & Sohlberg, 2002, p. 282), or similarly-phrased headings. In other literature the authors incorporate these ―implications‖ within the body of the work: ―If shame is one of the primary emotions identified, then this study suggests that it is important for clinicians to view the reduction of shame as a key factor in the treatment of PTSD (Harman & Lee, 2010, p. 22).

However, several papers take the treatment of shame as their primary topic, arguing for modalities that vary from Person-Centred to Cognitive Behavioural therapy.


Treatment and healing of shame

Among specific modalities discussed in the literature is Gestalt Therapy (Carroll, F., 2009; Erskine, 1995; Resnick, 1997; Wheeler, 1997). Resnick‘s (1997) article is of particular interest, offering in a manner that is neither dogmatic nor purist a reasoned critique of (Gestalt) approaches that he believes tend to ―violate Gestalt therapy‘s phenomenological, nonexpert, and dialogic relational position‖ (p. 269).

Other theorists find value in Cognitive Behavioural therapy (Feiring & Taska, 2005), Emotion-Focused therapy (Greenberg, 2008; Pascual-Leone & Greenberg, 2007), and Existential therapy (Goldberg, 1990), with each offering empirical or case study evidence to support their views. Forgiveness therapy from a feminist perspective


Shame: the ingenious quilt (McKay, Hill, Freedman, & Enright, 2007), and with a psychoanalytical twist (Lansky, 2009) also enter the therapeutic arena.

Self-forgiveness (Rangganadhan and Todorov, 2010) stands as a link between forgiveness therapy and several studies exploring the efficacy of self-compassion (Gilbert, Baldwin, Irons, Baccus, & Palmer, 2006; Gilbert & Irons, 2004; Gilbert & Proctor, 2006; Neff, 2003). Neff‘s (2003) paper anticipates the arguably-more-fullyformed theory described in Gilbert et al. (2006), Gilbert and Irons (2004), and Gilbert and Proctor‘s (2006) work, namely Compassionate Mind Training (CMT).

Gray (2009) argues for a ―person-centred framework‖ in treating clients with alcohol and other drug (AOD) problems who also exhibit shame issues (p. 1). She observes that it is especially necessary in situations where the stigma of AOD problems and the views of colleagues indicate a likelihood of further shaming of the client. Herman (2007), without specific reference to any particular modality, recommends a recognisably-person-centred approach, though for slightly different reasons. Her view incorporates known issues of transference and countertransference (Bromberg, 2001; Goldberg, 1990; Johnson, 2006; Jordan, 2001) and reiterates what Bromberg (1998; 2001) refers to as ―patience‖ (p. 891; p. 299). For Bromberg (1998; 2001), Goldberg (1990), Gray (2009), Johnson (2006), and Jordan (2001) a relationship of trust between client and therapist is a sine qua non of effective treatment – which is never to deny the same or similar viewpoint among practitioners and clinicians who work in other modalities.


Shame: the ingenious quilt 2.3.2

Concluding overview

The literature on shame is wide and varied. In part this is simply because of the many different ways shame might express itself, as some of the monographic literature suggests, for example Nathanson‘s (1987) Many faces of shame, and MiddletonMoz‘s (1990) Shame and guilt: the masters of disguise. That this review of the literature is not exhaustive, again reflects the breadth of topics the phenomenology of shame encompasses. Nevertheless, the researcher has attempted to examine those areas that are likely to be most prevalent in discussions of shame.


Shame: the ingenious quilt PART 3: 3.1


Introduction This study uses that method of qualitative research which is known as interpretive phenomenological analysis (IPA) (Smith, 2008; Smith, Flowers, & Larkin, 2009). Qualitative research is distinct from quantitative studies in obvious enough ways: the former is concerned with analysing the experience of participants, commonly through detailed study of verbal interactions to elicit meaning, nuance, and an understanding of the world as the participant experiences or has experienced it (Smith, 2008; Smith et al., 2009). Where IPA is the method of choice, the researcher‘s interpretive values are also acknowledged to be part of the hermeneutical process of producing a rich account of the data (Biggerstaff & Thompson, 2008; Smith, 2008; Willig, 2001). By contrast, quantitative research is interested in examining values converted into numerical form (Smith, 2008). Smith (2008) nevertheless points out that elements of each form of research can and do overlap: quantitative research, for instance, does involve interpretation of data, albeit numerical data, and some researchers produce a narrative based on that data. Similarly, qualitative research may arrive at cause-andeffect discussions and conclusions as might quantitative approaches (Smith, 2008).

IPA itself, developed specifically for and within the discipline of psychology and now expanding to cover other behavioural, social and health sciences, is a relatively recent research method (Smith, 2008; Smith et al., 2009). However, its intellectual roots go deep, with underpinnings in phenomenology and existentialism, hermeneutics, and idiography (Buchbinder & Eisikovits, 2003; Smith, 2008).

What, then, are those theoretical underpinnings?


Shame: the ingenious quilt 3.2

Interpretive phenomenological analysis: theoretical underpinnings 3.2.1


Edmund Husserl (1859-1938) developed phenomenology as a corrective methodology aimed at an all-encompassing reformation, not simply of psychology, but of all the intellectual disciplines – arts, physical and social sciences, and humanities (Ashworth, 2008). His critique of self-observational experimentation was the catalyst, but he was also trying to address fundamental flaws in behaviourism, cognitivism, and positivism (ibid.).

Husserl‘s contention was that researchers needed to deal with, examine, analyse the actual phenomena, to ―go back/return to the things themselves‖ (quoted in Ashworth, 2008, p. 11; and Smith et al., 2009, p. 12; inter alia!). What he meant by things was the conscious experience of an individual, upon which reflection (that is, consciously thinking about the experience) takes place at a later time (Smith et al., 2009). This process of intentionality begins with a deliberate setting-aside of assumptions and things the researcher might take for granted (ibid.). Loftus (2006) points out that intentionality has the sense of ―paying attention to‖ (p. 108), rather than its vernacular signification of wanting or planning for something to happen. Husserl called this part of the process bracketing (Ashworth, 2008), also known as the epoché (Giorgi & Giorgi, 2008). In other words, the researcher‘s presuppositions, assumptions, takenfor-granted things are bracketed away so that they do not, as it were, contaminate the experience of the thing under observation, thus freeing the researcher to concentrate their efforts on the ―lifeworld‖ of the ―thing‖, the phenomenon (Ashworth, 2008).


Shame: the ingenious quilt What follows in the phenomenological process Husserl devised is a series of ―reductions‖, gathered under a designation he termed ―eidetic reduction‖ (Smith et al., 2009, p. 14). This is an attempt to get to the core meaning of a phenomenon, the (eidos) or ―idea‖ or ―essence‖ of a thing (ibid.). The final result should be a description of what a phenomenon means in the lifeworld, or the ―practical and emotional features of‖ the phenomenon (ibid.).

Giorgi and Giorgi (2009) point out that although Husserl proposed a variety of reductions, the one most suited for psychological and related research is what Husserl termed ―phenomenological psychological reduction‖, which they rename ―scientific phenomenological reduction‖ (p. 33). The value of this method resides in its viewing of phenomena as ―presences, not realities‖ (ibid.). Such a viewpoint enables the researcher to observe the phenomenon as it is, in effect bracketing the whole question of what ―reality‖ means and epistemological issues such as what constitutes ―knowing‖ (Giorgi & Giorgi, 2009, pp. 33-34).

Giorgi and Giorgi (2009) then describe the four basic steps in conducting this kind of scientific phenomenological reduction. First, read the description of the phenomenon being studied, which, in terms of this research project, means listening to the recorded interview, as well as reading the subsequent transcript of interview (Giorgi & Giorgi, 2009). Second, the researcher carefully re-reads each data sample with a view to tracking changes and transitions in meaning (ibid.). Giorgi and Giorgi (2009) point out that ―meaning‖ in this sense is not an objective reality but rather is dependent upon and uniquely linked to the elicited meaning the data themselves reveal [emphases added]. The third step involves tracking what Giorgi and Giorgi (2009, pp.


Shame: the ingenious quilt 35-46) call the ―transformations‖ that will help broaden what is evident in the data. This is a process of creating a language that ultimately makes communication of the findings accessible to another reader, which constitutes the fourth and final step (Giorgi & Giorgi, 2009). This fourth step involves determining a structure or several structures, if necessary (ibid.). Giorgi and Giorgi (2009) counsel the researcher not to ―force the data to fit one structure‖ (Giorgi & Giorgi, 2009, p. 46). The final (fourth) part of the process allows the data to speak on its own terms, but also enables nuances of general meaning, for instance, using Giorgi and Giorgi‘s (2009) example, the difference between feeling ―anxiety‖, on the one hand, and feeling ―fearful‖, on the other (p. 47).

Once the researcher has laboured through these four steps, it is possible to write up the findings and present them in a form that Giorgi and Giorgi‘s (2009) ―competent colleague‖ can then read (p. 47). As they observe somewhat laconically, ―Without the reading of a research report, the entire process becomes practically useless‖ (ibid.).

The phenomenological framework, however, is not solely dependent on Husserl‘s work (Giorgi & Giorgi, 2009). Husserl‘s one-time student, Martin Heidegger (18891976), posited a shift from Husserl‘s perceived abstractness and developed a philosophical stance whose main trajectories were ontological and hermeneutical (Smith et al., 2009). His concern was the question of humankind‘s being in the world, for which he coined the term Dasein, literally ―there-being‖; at the same time, he wanted to know how individuals made sense of the world into which they were ―thrown‖, how they created meaning in a world that was pre-existent and contained,


Shame: the ingenious quilt in his thinking, no ―given‖ meaning, other than the inter-relatedness humankind perceived upon discovering their existence, their Dasein (Smith et al., 2009). Maurice Merleau-Ponty (1908-1961) argued for the importance of humankind‘s bodily manifestation and their distinctiveness and distinction3 from everything and everyone else in the world (Smith et al., 2009). Smith et al. (2009) observe, ―My perception of ‗other‘ always develops from my own embodied perspective,‖ (p. 19). However, it is a unique viewpoint because each body is unique and perceives the other in a way that is singularly differentiated from any other‘s perception (ibid.)

Jean-Paul Sartre (1905-1980) also extended aspects of phenomenology, though with possibly a more existential ―twist‖ (Smith et al., 2009). This is not to say that Heidegger and Merleau-Ponty did not have an influence on existential thinking, but Sartre‘s contribution contains a particular nuance that further influences IPA (ibid.). Sartre‘s viewpoint is succinctly summarised by Smith et al. (2009): ― His famous expression ‗existence comes before essence‘…indicates that we are always becoming ourselves, and that the self is not a pre-existing unity to be discovered, but rather an ongoing project to be unfurled‖ (p. 19). What this leads to, therefore, is an emphasis on engagement with and in the world as the individual unfurls more of their self (ibid.). This too is a consequence of becoming rather than being: individuals are free to make choices as they engage the world in the process of their unfurling (ibid.). In all these respects, absence (nothingness) is of equal significance to presence (ibid.).


Interestingly, medical science tends to confirm this perspective: every body, literally, is different. Treatment, especially pharmacological treatment, proceeds, not on the basis of ubiquity and universality, but in terms of probabilities. Therefore, for any given pathology, only x% of patients will benefit, while it is likely that y% will not. The effectiveness of treatment becomes increasingly complex when “side-effects” are accounted for.


Shame: the ingenious quilt In summary, Husserl gives IPA the notion of phenomena and their importance as the primary ground of research. Husserl enjoins the researcher to ―return to the things themselves‖. Heidegger thought this may be too theoretical and advocated a view of humankind being in the world, asking how their ―lifeworld‖ contributed to meanmaking as individuals came to realise their relationship with their world. IPA recognises that interrelatedness is an important factor in the research and analysis of the individual‘s lifeworld. For Merleau-Ponty, the important aspect of being in the world was humankind‘s embodiment: human beings are bodies in relationship with one another and the world around them. But each body is distinct and unique, thus bequeathing IPA the task of analysing each participant‘s data on its own terms, not as evidence of generalisability, but as a singular statement based on that individual‘s lifeworld, whatever might be their relationship with an other or the things around them. Sartre‘s view that the individual is becoming rather than already known in their entirety as a being, and is engaged in the world, in embodied relationship with others, present or absent, informs IPA‘s analysis of the influence of others on the participant‘s lifeworld.



Hermeneutics preceded phenomenology, and arose from a concern with establishing a sound basis for interpreting scriptural texts (Smith et al., 2009). Among the influential thinkers on hermeneutics, the ―theory of interpretation‖ (Smith et al. 2009, p. 21), was Friedrich Schleiermacher (1768-1834), whose position on hermeneutics was that texts are creations that both the writer‘s ―linguistic community‖ and the writer themselves influence (Smith et al., 2009, p. 22). He believed that the reader was able to interpret


Shame: the ingenious quilt the text, provided they were mindful of contextual issues significant for that text (ibid.).

Heidegger also contributed to hermeneutical thinking and produced two influential ideas for IPA (Smith et al., 2009). The first is the view of Dasein, the person being thrown into the world and having to make meaning from their lifeworld (Ashworth, 2008; Smith et al., 2009). Second, Smith et al. (2009) argue that Heidegger‘s phenomenology questions the possibility of bracketing preconceived ideas entirely, because those preconceptions may not be evident until the researcher begins the analytical work [emphasis added].

The third hermeneutical thinker whose work has influenced IPA is Hans-Georg Gadamer (1900-2002). In his dialogue with Heidegger‘s notion of interpretation and preconceptions, Gadamer argued that the process of interpretation could effectively be cyclical in that the phenomenon in question can influence the interpretation, which can reveal the preconceptions, which can subsequently have the effect of impacting upon the (new, next, revised) interpretation (Smith et al., 2009). Gadamer‘s dialogue with Schleiermacher saw him disagreeing with the latter‘s assertion that it was possible to know the author and the author‘s intention by studying the author‘s text, contending instead that interpretation happens in the present moment and it is in the present moment that anything learned from the text applies (Smith et al., 2009).

A final consideration on the topic of hermeneutics is the hermeneutic circle, an approach that uses a reflexive relationship: ―part‖ and ―whole‖ are understood with reference to each other (Smith et al., 2009). This accords with IPA‘s iterative


Shame: the ingenious quilt approach, in which the researcher ―move[s] back and forth through a range of different ways of thinking about the data‖ (Smith et al., 2009, p. 28).



The idiographic4 approach is about uniqueness and particularity (Ashworth, 2008). Gordon Willard Allport (1897-1967) expounded the principles of idiography as a corrective to a psychology that seemed uninterested in the individual, seeing them only in relation to general laws that science had the task of revealing (ibid.). This ―nomothetic‖5 approach fails to account for the unique and particular perspective each individual might potentially offer (ibid.). IPA‘s method of examining the particular phenomenon in detail, and also its determination to focus on the particular insights of particular participants, makes idiography especially suitable as a theoretical base (ibid.).

A crucial implication of idiographic particularity is that it allows for small sample sizes (Ashworth, 2008). Unlike its nomothetic counterpart, whose concern is revelation and explication of general laws and therefore requires increasingly larger sample sizes for accurate and legitimate outcomes (Neuman, 2006), an idiographically-informed IPA project can achieve valid results with as few as one participant (Smith & Osborn, 2008; Smith et al., 2009).

Ultimately, IPA is not seeking to draw universalising conclusions in the same manner as quantitative analyses might (Yardley, 2008). However, with its concern to elicit rich, ―thick‖ descriptions of particular phenomena, IPA remains hopeful that those 4 5

Greek Greek

(idios), one’s own, peculiar, hence by extension, particular nomos law.


Shame: the ingenious quilt descriptive narratives may produce results that support ― ‗theoretical‘, ‗vertical‘ or ‗logical‘ rather than statistical generalizations‖ (Yardley, 2008, p. 238).


Method This section, following the suggestions of Smith et al. (2009), outlines the various steps involved in selecting participants, describing the participants, description of the data collection instrument, the interview process and its particulars, and the ―sequence of analysis‖ (p. 112).


The sample

The researcher decided on a sample of four participants, chosen in the first instance on the basis of broad homogeneity of profession (Smith et al., 2009).

The researcher initially contacted the Secretary of the Psychotherapists and Counsellors Association of Western Australia (PACAWA), explaining the nature of the study and asking if PACAWA members could be canvassed to determine whether there were any interest in participating in the project. The Secretary‘s advice was to consult the Member Directory and contact members directly, which is how the researcher selected two of the eventual participants.

The other two sample members were chosen on the basis of informal word-of-mouth recommendations.

The researcher‘s belief was that four participants would offer a good balance of perspectives: more than four might have become too unwieldy a number and might


Shame: the ingenious quilt have affected the subsequent analysis of data in a deleterious manner, given circumscribed time constraints. Similarly, fewer than four participants may not have provided sufficient breadth of viewpoint and experience with regard to the research question.

Prospective participants were listed with contact details (typically a phone number, but sometimes an email address) and the actual process of selection involved contacting these prospects by phone. Several were unavailable and did not respond to the message the researcher left on their answering machines. When the researcher was able to speak with a prospective participant, he explained who he was (a Master of Counselling student at the Fremantle campus of the University of Notre Dame, Australia), and the nature and aims of the project. The researcher asked whether the prospective participant would be willing to be interviewed and he explained how the interview would proceed.

All of the prospects to whom the researcher spoke directly agreed to participate. Researcher and participant then negotiated a mutually-agreeable date, time and place for the interview to take place.


The participants

As Table 1 illustrates, the sample consisted of two female and two male therapists. Two drew clients from the general population, that is to say, their practice did not, at the time of the interviews, specialise in a particular population. However, two of the therapists had specific areas of interest: Sexual abuse, and Domestic violence.


Shame: the ingenious quilt

Table 1: Participants PARTICIPANT





General population


Clinical Psychologist

Sexual abuse



Domestic violence


Occupational Therapist, Counsellor and Psychotherapist

General population

In terms of sex and professional population, the choice of participants seemed to offer a balance of perspectives. Shame theory suggests that abuse of any kind is likely to leave a legacy of shame proneness or lie behind shame-based pathologies (Bradshaw, 1988; J. Brown, 2004; Buchbinder & Eisikovits, 2003; Engel, 2006; Farber, KhurginBott, & Feldman, 2009), but the researcher was also interested in what therapists with a general caseload might experience with their clients. Although gender may be an issue in therapeutic interactions, results are ambiguous: the researcher did not consider this a major limiting factor (Blow, Sprenkle, & Davis, 2007; Creamer & Liddle, 2005; Miller & Ivey, 2006).

The participants also possessed varying levels of experience although all were tertiary-trained and in professional practice. With the caveat that such figures may be misleading when considering efficacy, the experiential range was five years‘ to more than forty years‘ experience as therapists. For the purposes of this study, the range seemed a mix, providing good variety within the homogeneity.


Shame: the ingenious quilt 3.3.3

The data collection instrument – interview schedule

The researcher followed the outline given in Smith and Osborn (2008), planning to collect data by means of semi-structured interviews (p. 58). The advantage of the semi-structured interview approach is that it has at its base a flexible data collection instrument – in this case an interview schedule (Appendix C) that consisted of seven separate questions related to the research aims.

Flexibility of approach was the key consideration. The interview schedule would serve as a starting point and be available as ―back-up‖ if a participant seemed to lack anything further to impart. However, the research plan was to ask the initial question or questions and then follow the train of thought of the participant, allowing them to reveal their lifeworld in their own words, paying attention to their own experience of the issue at hand, in this case, shame and how shame related to the presenting issues of their clients.

To this end, the researcher had at his disposal ―adjunct‖ questions in the event that a participant spoke of an issue that seemed especially relevant or revelatory. Such questions included, but were not limited to: ―Could you tell me more about…?‖; ―You mentioned… Can you explain what you mean by…?‖; ―That‘s an interesting distinction. How are you making that distinction?‖ These adjunct questions were not written down, but rather remained available to the researcher for use as and when he considered them useful to employ.

The researcher particularly wanted to avoid ―leading‖ questions, or questions that might allow the participant to provide answers or responses the participant thought the


Shame: the ingenious quilt researcher wanted to hear. This is another advantage of the semi-structured interview technique. The in-built flexibility places a certain responsibility on the participant to offer their own lifeworld responses rather than bespoke or crafted answers that don‘t necessarily carry that lifeworld authenticity. But it is a shared responsibility: the researcher also has to encourage the participant to speak about their lifeworld rather than an imaginary or inauthentic one.

The questions in the interview schedule were deliberately constructed as ―open‖, as opposed to ―closed‖, questions. In other words, where the researcher asked a schedule question, the participant would have to provide a considered answer, not the ―Yes‖ or ―No‖ response closed questions commonly elicit. Again, it seemed more likely that the participant would speak of and from their lifeworld if they were responding to a question that required some consideration of their own experience.


Interview particulars

The semi-structured interviews lasted from 48 minutes (the shortest) to 56 minutes (the longest). Each participant was informed at the initial contact stage that the interviews would be recorded. Each interview was recorded using a Philips Voice Tracker digital voice recorder. The researcher double-checked before each interview began that the participant was agreeable to the recording of the interview. All assented without expressing concern.

Each participant was given an Information Sheet (Appendix B) before the interview, which provided details of the interview process and ethical issues such as confidentiality, secure storage of data gathered, and appropriate channels of complaint


Shame: the ingenious quilt or grievance should such issues arise. The Information Sheet also confirmed that ―the Human Research Ethics Committee of the University of Notre Dame Australia has approved the study‖.

Each participant received and signed the appropriate Consent Form (Appendix A).

Also prior to commencement of each interview, the researcher sought the participant‘s permission to take hand-written notes. Again, each participant assented without expressing concern.

Once the interviews were recorded, the resulting MP3 file was copied onto the researcher‘s computer and filed in a secure folder. Each digital file was given a filename using the formula SI n YYYYMMDD, where SI is an abbreviation for Shame Interview, n is the chronological number of the interview, and YYYYMMDD signifies the date6: year (in full); month; and day. No identifying information was included, either on the filename or the notes.

Once recorded, interviews were sent to an off-site transcription service in the eastern states whose practice is dedicated to the transcription of postgraduate work of the kind in which the researcher was engaged. The transcription service is fully conversant with issues of confidentiality. All digital files and subsequent transcriptions are destroyed after completion of each assignment.

Transcriptions were filed with the relevant digital recordings. 6

The YYYYMMDD formula is an internationally-recognised format that allows ease of sorting large volumes of date-significant data.


Shame: the ingenious quilt The interview technique is best described as analogous to a person-centred therapy (PCT) session. The interviewer adopted a stance of unconditional positive regard towards each participant, and used typical PCT minimal encouragers to convey his interest and desire to hear more. The adjunct questions mentioned earlier were phrased in a respectful, non-demanding way. Attentive listening was a key component of each interview, as was observation of non-verbal cues, although the researcher did not challenge or confront, as perhaps he might in a therapeutic setting.


Sequence of analysis

While waiting for the transcripts the researcher began the process of analysing the interviews by listening to the interviews several times. The interviews were also burned onto unidentified CDs and the researcher continued the listening process while driving. This part of the analysis gave the researcher a better understanding of the way each participant spoke, and presented and organised their information and responses.

When the transcripts were available the researcher read and re-read each transcript in turn, again with a view to eliciting a ―feel‖ for the each participant‘s style of communication, as well as, at this stage, a casual mental noting of discernible themes.

The task of analysis-in-earnest began as each transcript returned. Received as a digital file, the transcript was then printed so that the process of coding could begin. The audio-immersion period described above was invaluable when it came to reading and re-reading the transcripts themselves because the words-on-paper allowed a ―fixed‖ sense of the interview to begin to materialise, in most cases confirming the


Shame: the ingenious quilt researcher‘s initial impressions, but also providing additional insights or clarifying points of ambiguity. All outcomes proved helpful.

Themes were gleaned during the reading process and noted on systems cards. This was done for each interview transcript. In this part of the analysis the participant‘s words provided the language.

However, a comparison/contrast analysis of initial themes allowed for combination and conflation of participant themes into a more generalised language that would make subsequent communication of the findings more accessible for other readers. At this stage the researcher began colouring in the transcripts using fluoro highlighter pens so that the generalised, conflated themes could be seen more readily on the page.

In this latter part of the analytical process the researcher‘s interpretations of each participant‘s lifeworld was most clearly in focus. As certainly as any rendering of one language into another, the process of generalising participant concepts required interpretive decisions. For instance, several participants spoke, some at length, some with particular reference to theorists, about developmental issues relating to shame. The researcher had to decide how to group these (and other, similar) trajectories. Was this an issue relating to General shame theory? Perhaps the most straightforward thematic group would be Developmental issues? The researcher‘s final decision was to use the phrase Foundational issues, partly because it suggested the early-stage locus of shame pathology, encompassing developmental theory, and partly because foundational conveyed that sense more accessibly than the arguably more technical developmental.


Shame: the ingenious quilt PART 4: 4.1


Introduction As described in Part 3, the analysis of the participant interviews reduced iteratively to a number of key themes, with a number of sub-themes also evident. Table 2 sets these out for ease of viewing.

Table 2: Themes and sub-themes




Foundational issues

Developmental issues Attachment

Shame theory

Cultural issues Gender issues Guilt

Presenting issues

Child sexual abuse (CSA) Domestic violence (DV)


Psychodynamic Eclectic Narrative

Thematic narrative 4.2.1

Foundational issues Once upon a time and a very good time it was there was a moocow coming down along the road and this moocow that was coming down along the road met a nicens little boy named baby tuckoo. James Joyce A portrait of the artist as a young man

It is a sad and tragic thing that not all childhoods contain memories as sublime as Stephen Dedalus‘s seem to have been as Joyce‘s novel begins. Shame theory suggests that a strong link is evident between shame and ruptured attachment bonds (Bowlby, 2005; Engel, 2006; Hansen, B., 2006; Marmarosh, Whipple, Schettler, Pinhas, Wolf, 49

Shame: the ingenious quilt & Sayit, 2009). As one participant expressed the issue, with a forthright absence of ambiguity:

Well in my experience, there‘s a very clear link between childhood victimisation and shame and the crimes they subsequently commit. [SI 2]

Although at this point the participant is thinking about a serious and traumatic shattering of attachment through childhood sexual abuse, they go on to say,

There‘s no, like, I‘m wanting to make perhaps a distinction that even the shame that people subjectively experience in adulthood, to my mind, comes from their childhood emotion of shame. [SI 2]


And so it‘s integral really that there is a relationship [between childhood shame and offending] and it‘s key. But it might well be the childhood one, not the adult one. [SI 2]

One participant spoke in more general terms about the influence of childhood experience on shame. As they explained:

Um, you see, one of the pernicious elements of shame is that it—because it, the foundation is established usually very early on in the client‘s life, in their childhood, what children experience they tend to see as natural. They tend to


Shame: the ingenious quilt see that as, you know, ―The reason this person looks at me in this way and treats me in this way is because I deserve it,‖ or, ―It is just the way things are.‖ You know, there is a truth in it and therefore they won‘t—they tend not to use the word shame because that‘s a word that starts to explain what has happened to them. In other words, for the client, it is just what it is. It‘s that they feel bad about themselves and that‘s what they are more inclined to say. They are more inclined to say things like, ―I‘m hopeless. I‘m lazy.‖ They might say, ―I feel really bad about myself.‖ Or they might say, ―I hate myself.‖ They might say, ―I‘ve done very bad things.‖ But they‘ll tend not to use the word shame because that is a word that starts to explain something. [SI 1]

In this instance the participant‘s observations overlap with the theme of Presenting issues, but the key thinking touches on both attachment loss and developmental theory. This participant is explaining in theoretical terms how the affect, shame, can become internalised in childhood and cause problems in adulthood. Erikson‘s developmental theory understands this as a failure adequately to negotiate the secondstage ―task‖, autonomy versus shame and doubt (Erikson, 1995). Such a failure might lie behind some of the example statements the participant offered: ― ‗I‘m hopeless. I‘m lazy.‘ ‗I feel really bad about myself.‘ ‖ These are indicators of the feelings of worthlessness and powerlessness that often accompany shame, or which shame-based people might articulate about themselves.

This participant also made some insightful comments about the role and significance of imagination in the internalisation of shame, a perspective that the researcher had not previously encountered.


Shame: the ingenious quilt The participant‘s initial observation here was,

You know, human beings are separate. Their interiors cannot really infect each other but they do so through the work of the imagination. And so, let‘s say this now about shame: shame has an imaginative quality as well. Shame only works—I can only shame a person, a person can only be shamed if they believe or imagine that a message that they are receiving is one that is really going to deeply be critical of them. [SI 1]

The remainder of the exchange is set down as it happened, continuing from the statement recorded above:

Interviewer: Yes. Participant: In other words they have to engage with it at the level of imagination. Interviewer: Hm. Participant: They have to say, well, this is right, ―I am filthy,‖ or ―I am dirty,‖ or ―I am a failure,‖ or ―I am lazy‖. So imaginatively, they have to connect with a message they are getting. Otherwise the message is impotent. It will have no effect on them. Interviewer: Yeah. Participant: So what we want to do in therapy is we want to disarm the affect of the imagination. We want to take out the imaginative, the imaginary element of that by speaking about it. We want to make it, we want to turn it into words, we want to turn it into


Shame: the ingenious quilt sentences and language so that we can actually be clear about what‘s going on. [SI 1]

A little in the interview the following exchange added to the participant‘s viewpoint:

Participant: Imagination can play havoc and so ... Interviewer: Well, yes. Participant: ... as far as children are concerned, when parents don‘t speak and when parents remain silent and convey subtle messages it‘s the child‘s imagination that then goes to work on that and starts to turn it into something that will be eventually pathological for them. [SI 1]

In this more concrete observation the participant comments upon the interplay between parents (or caregivers) who shame, and the manner in which a child might, through the imagination, create a self-injuring psychic wound. This is an early dynamic, which means that

It is difficult to work with shame. It‘s a very sticky—because the foundations of it are laid so early in a person‘s experience it‘s very difficult to move… [SI 1]

However, it may be that the foundation stone of shame precedes birth, and is part of the child‘s development in the womb. As another participant commented:


Shame: the ingenious quilt I think it is we are hard wired as a group species, er, and I think shame is around belonging to the group, to the clan, or to the immediate—having an immediate other, so I think shame is hard wired into our, um, our way of attaching and bonding. [SI 4]

This is essentially a neurological perspective and may suggest that human beings are more disposed or potentially vulnerable to shame and shaming than previously thought.


Shame theory I wouldn’t want to belong to a club that would have me as a member. Groucho Marx

All of the participants spoke about shame from theoretical viewpoints during the course of the interviews. This is not to say that theory was the primary concern of any participant, but rather suggests that they all were conversant with significant theoretical issues underpinning their preferred modality and practice.

The researcher identified three sub-themes:

Cultural issues

Gender issues

Guilt – as a contrasting feeling to shame, and possibly also a confusion with shame


Shame: the ingenious quilt One participant mentioned the phenomenological manifestations of shame, contrasting shame with guilt:

I tend to think of shame as, in many ways, I distinguish it from guilt in terms of being a visual, having a visual element. Someone who is suffering from shame is suffering from a notion to do with being seen in a certain way. So, very often shame has much more marked physical symptoms than what we might think of as guilt. [SI 1]

This is very much at the core of shame. It manifests in the body, causing not only the intense emotional pain that is so often described, but also a somatic response, perhaps most notoriously blushing, both of which phenomena can give rise to a desperation to hide, cover up, seek to disappear (Cozolino, 2006; Heller, 2003; Tangney, Mashek, & Stuewig, 2005).

The participant in this instance provided two cogent examples of shame embodiment:

Participant: So whereas a person might be operating perfectly normally in the world with a burden of guilt, what you will see with someone who is carrying a huge burden of shame, I notice you use the phrase ‗toxic shame‘ in your introduction, um, this person will very often just display a physical symptom that shows that they are struggling with being seen physically and experiencing a shame around that, that physical, er, their physical being as it exists in the eyes of somebody else. And so,


Shame: the ingenious quilt what I‘m trying to say is if someone is suffering from toxic shame they will imagine that somebody is looking at them all the time and making a detrimental judgment of them and that this will display itself in their bodies in some way. Interviewer: Could you give an example of how ... Participant: I‘ll give two examples. A client who grew up in a very austere, Calvinist household which didn‘t allow for any expressions of joy or warmth or affection and any attempt to do any of these things would have been severely punished and criticised. She now suffers from an inability to move her body freely. She walks stiffly. She can‘t swing her arms by her side. She is unable to dance. Her body is in a way, has been made rigid as though she is still under observation, still under surveillance from her father and that she feels her body to be potentially an object of shame should she express anything joyful or remotely sensuous or anything of that nature. Another example of a physical manifestation of a burden of shame would be to do with skin afflictions and so clients that have skin - problems with their skin, and er, because the skin is the surface upon which the gaze of other people lands. So, coming back to this idea of someone suffering from shame feels they are being looked at with criticism and with judgement very often you‘ll see skin problems that I think of as a psychosomatic manifestation of their shame burden. [SI 1]


Shame: the ingenious quilt Sometimes, however, the person doing the looking and putative judging is not an ‗other‘ but they themselves. Participant: The word shame is rarely used actually, when I think about it, hm. What is apparent is what this particular person would say er, when she looked in the mirror at herself. Interviewer: Hm, yeah, okay. Participant: ―Bitch, bitch, bitch, stupid, stupid, stupid‖. The other manifestation of it Al, was um, my interest is narrative therapy, that‘s my, my passion if you like, and um, what would happen with this person; her sense of worthlessness, she would come into a session, postpone the next one, make another appointment, then bring a friend and I, at the time, I thought why had she brought a friend, then it made sense. She wants to come, so to overcome that sense of worthlessness she would get a friend to be with her so she wouldn‘t let her friend down Interviewer: Hm, right, yeah. Participant: And on other occasions she would um, say, ―I‘ve only come for five minutes ‗cause I‘m waste—I‘m wasting your time, I‘m sure there are better things for you to do with your time,‖ so that sense of that, but at the same time there was a sense of her, something she did want and that struggle between the two and er, she‘s overcome that now. But that was that sense, of yeah, worthlessness. And we eventually called it that. We called it self-hate which one of the consequences was that sense of worthlessness. [SI 3]


Shame: the ingenious quilt

Several of the observed and noted manifestations of shame are present in this excerpt. The overwhelming sense of worthlessness, chained rather than simply allied to the self-hate, expressed as vituperative loathing as the client screams at herself (or her Self) reflected from the mirror, the insistently self-dismissive monologue, ―I‘ve only come for five minutes ‗cause I‘m waste—I‘m wasting your time, I‘m sure there are better things for you to do with your time‖, all accord with shame theory (Engel, 2006; Lewis, 1995; Lewis, 2003).

Sometimes, however, focussing on negative self-talk can be turned around to become a therapy tool:

Like if a person is in a state about something in the present then I will work in the present as well and not always go back um, to kind of um, unveil their negative self talk or say, for example, in talking with somebody about feeling shame in the present, I might go back and ask them to think about what‘s triggered it. What is the activating event and what‘s their way of talking about it. And, some of the ways that trigger the shame are, ―I should‘ve known better,‖ or ―There‘s something wrong with me that I didn‘t do this,‖ or ―This person has found me out‖. You know, so all sorts of self talk ... [SI 2]

The participant continued:

... can lead to the experiential, um, the feeling state of shames or um, depression and to unpack that and to get them to be able to exercise control


Shame: the ingenious quilt over it we go and re-visit that self-talk and say, it would‘ve been—would‘ve been more helpful if I‘d done something different but I, you know, I, it‘s not the end of the world that I didn‘t. You know, so, challenging irrational beliefs is another one I use. Teaching people how to be assertive rather than aggressive ... [SI 2]

As already noted with regard to attachment theory, a severing or rupture of the attachment bond between parent/caregiver and child can have shaming consequences. One participant considered this relational aspect to be crucial, not only in terms of childhood attachment, but throughout the lifespan:

Um, but you know, shame can occur without any external involvement. Er, we know that shame can happen in a small child just in a realisation that you‘ve done something outside of the group, or sometimes shame can occur simply because you‘re exposing something. No one‘s behaved badly or even noticed, but one‘s self noticing gives rise to shame in children. I think that continues throughout life. So it‘s one of those hidden, er, systems that catch people unaware and instinctively we will do anything to avoid it. It‘s the worst feeling you get because it knocks out your existence relationally with others. [SI 4]

Two of the participants mentioned cultural issues with regard to shame. One used culture to illustrate the general difference between a shame-based and a guilt-based culture:


Shame: the ingenious quilt Well, yes, I don‘t—well, yes, it is interesting and I‘ve—but I think I‘ve been fascinated by the studies of different cultures and the shame-cultures versus the guilt-cultures, you know, for example there is some writing about – I can‘t remember the reference now but about Aboriginal culture being a shamebased culture and say something like Judaism coming from a guilt-based so that you have to have the kind of legal and of breaking the law concept before you can actually have guilt. [SI 2]

The distinction is useful because developmentally shame precedes guilt in Erikson‘s theory, which suggests that to have a working concept of guilt and law-breaking a child must be aware of the existence of others. By contrast, the shame-based child has been driven inwards because their attempts to explore independence have drawn shaming or otherwise abusing reactions from others, most notably parents or caregivers. The child‘s striving for autonomy has therefore been forestalled and prevented, and because the child is only very imperfectly able to see themself as separate from parent/caregiver, they come to believe and internalise shaming reactions as an accurate reflection of who they are.

For the second participant who spoke of cultural issues in relation to shame theory, the focus was more specific, offering a contrast between how aboriginal society had once viewed shame, in comparison with the western perspective:

But the version it takes—it‘s interesting with Aboriginal people when I worked I did the um, trained group of, two groups of Aboriginal women in counselling ten years ago, um, and it was very interesting working with that


Shame: the ingenious quilt culture because I did discover shame operates in both cultures, but their version of shame is quite a different qualitative experience to western shame. [SI 4]


So, in Aboriginal, shame is warmer, it‘s not cold like it is in Western culture. [SI 4]


So in western culture it‘s like saying, ―You‘ve gone over the line. You don‘t belong with us‖. With Aboriginal culture it‘s like ―You‘re going over the line, heh, come over here,‖ with a laugh. [SI 4]

Aboriginal culture valued belonging and relationship as much as western societies but shame was used to restore broken relationships.

They understand shame is about going outside and er, loosing yourself out in a group. Well, I suppose if you develop that out in the desert, there‘s nowhere for the person to go. You can‘t exist on your own so it‘s like, ―Heh don‘t do that dumb thing to yourself. Come over here. You belong with us‖. So it‘s actually the reverse, ―You belong with us‖. Versus in our culture it is ―You don‘t belong with us. You‘re nothing, you‘re an object, you‘re not one of us‖. [SI 4]


Shame: the ingenious quilt Unfortunately a negative transformation has since occurred:

Yeah, I mean they have, they have the critic, they have a lot of guilt, they suffer from all those things and of course their culture now is very shamebased because of the abuse, generations of abuse and it‘s now internalised; operating internally. [SI 4]

This conversation about culture widened eventually to consider a world of shifting lifestyle upon which modern technology was also impinging. Still talking about aboriginal culture, however, the participant spoke about the shame that aboriginal men feel when they are unemployed:

Participant: And that, it‘s interesting that a lot of violence comes up around unemployment; times of unemployment where men don‘t have a source of self-esteem or belonging and so they attack whatever is close. Interviewer: Yes, are we talking simply about the breadwinner notion? Participant: Er, is it more the breadwinner? It‘s actually having a place in the world. Interviewer: Hm, mm. Participant: It‘s much more than earning money. Interviewer: Oh yeah, yeah. Participant: It‘s about one‘s masculine identity I think. I think that‘s why the Aboriginal men have struggled so severely and not lived very long.


Shame: the ingenious quilt Interviewer: Yes. Participant: Because they haven‘t found a place in the world. It‘s not just ―I haven‘t got a job‖. But there‘s no purposeful, meaningful engagement that betters the group or betters the clan or the family, er, it‘s not just about money because they don‘t care about money just to some degree and getting welfare keeps the food coming so that doesn‘t solve it . Interviewer: Hm, yeah, yeah so there‘s a sense of real displacement ... Participant: Yeah. [SI 4]

Shame abounds in the absence of pride about one‘s place in one‘s society. When that sense of place and therefore purpose is unavailable, it is not surprising that anger and violence become unhealthy, unhelpful means of dulling the agony of shame. Shame theory would confirm the relationship between anger, violence and shame (Bradshaw, 1987; Engel, 2006; Hansen, 2006). The participant had this to say:

Participant: Well it‘s loss of context in which they can um, be fruitful and achieve and feel proud, pride, so I think the other side of shame is proud, pride is the other side of shame. Feeling proud of oneself. Proud of one‘s contribution, proud of one‘s place, proud of one‘s clan or group. Identified with those things and those people and a sense of goodness arises inside. Interviewer: Hm, mm. Participant: So maybe that‘s partly the, um, the kind of growing that needs to happen. People finding some sense of worth in who they are


Shame: the ingenious quilt just as they are and to find expression by that worth. So it‘s not enough just to feel it but it actually needs to be expressed in life. [SI 4]

From what this participant had said, men could feel the effects of shame during times of unemployment. But where and how did women fit into shame theory? Another participant, when the researcher asked about gender differences, responded:

Interviewer: Yes. Getting back to that, the gender things, you mentioned that with men they might usually present as suicidal whereas women might present as disempowered. Participant: Hm. Interviewer: Are there other differences? Participant: In gender issues? Interviewer: In gender issues, yes. Participant: Hm. No, not really. There‘s more similarities between both men and women apart from that. Like, um, the issue of being a victim of life, you know, a victim of all sorts of things. Um, that‘s common to both men and women. Like the disempowerment. Like I think—I guess I use the suicidality aspect because that is the most marked difference and all it might be is an intensity of shame, because usually the people that are like that have just been picked up for child internet pornography or child sexual abuse or something about which they‘re intensely, you know, they‘re devastated and they know


Shame: the ingenious quilt that they‘ve let their families down, etcetera, and they‘ve always had this background intention that, ―If this ever comes to light I‘ll top myself‖. Then of course it comes to light so of course that‘s where they immediately go. ―I‘ll kill myself‖. Because they don‘t actually know of any other avenue of hope. That‘s when they usually get referred to me by whatever crisis line or police or whatever. And, um, that‘s when they get this glimmering of hope that there could be a different way forward that isn‘t totally destructive. Whereas women aren‘t usually in that kind of situation; they‘re more feeling persecuted and um, unable to function by some kind of external relationship of sorts. And I‘m not saying men don‘t become like that as well, but to me, it‘s the other kind is more obvious, um, the more intense. I do get people who are chronically depressed, men, and they‘re more similar to like women adult survivors. They don‘t actually know what‘s wrong with them but they‘ve been like this for a long time and it doesn‘t take long to find out that it‘s to do with some kind of childhood issue. [SI 2]

For another participant, shame where gender was concerned was something that women living with domestic violence (DV) or childhood sexual abuse (CSA) were likely to feel. Shame theory affirms the powerful links between abuse and shame (Lisak, 1994; MacKinnon, 2008). The participant did, however, recall two cases where men exhibited such a low level of self-worth that shame suggested itself as a likely issue:


Shame: the ingenious quilt He said, ―I nearly didn‘t get here today‖. I said, ―How come.‖ I expected him to say the car broke down. He said, ―Oh,‖ he was not working at the time. He said, ―Oh, I started to think, oh, you never finish anything, you‘re just a waste of time, what‘s the point of starting, um, and um, you know, you start things and you never finish them. Kids reckon you‘re a waste of space‖. I said, again it‘s the same thing with that woman. I said ―How come you managed to get here, you got all these thoughts telling you not to?‖ He said, well I knew I wanted to come. So I told my partner what I was thinking and she said, ―No, no, I‘ve got faith in you, you go and do it ...‖ you know, because she knew of the goodness in him… [SI 3]

One viewpoint initially surprised the researcher:

Um, (pause), well I think shame is very primary for men other—because er, women are more relational. [SI 4]

However, Osherson and Krugman (1990) observed, citing Helen Block Lewis‘s important text, Shame and guilt in neurosis: ―While it has been argued that women are shame prone (Lewis, 1971), we have come to believe that men are more shame vulnerable‖ (p. 327). If, as this participant suggested, women are more relational than men, then it is possible that women have a greater capacity than men for re-bridging the damaged or destroyed attachment divide. On the other hand, if men are less relational than women, men will possibly remain isolated or alienated or at risk where shame is at issue.


Shame: the ingenious quilt Participant 4 continued:

So we know that the brain is different between men and women. We know that women on the whole, and gay men, have a high—more equal left and right brains so—and also the corpus callosum; they talk to each other. [SI 4]


So they [women] have more resourcing as to how to survive. [SI 4]

This is reflected in the likelihood of women and men seeking therapy:

Oh, men are different to women, yeah, definitely. Er, and I think it‘s interesting because the statistics around counselling is woman will more easily go to doctors, they‘ll ask for help, they‘ll reach out, so they tend to be the ones who use counselling services but you will find that certain counsellors have as many men as women and I would say at the moment probably I‘ve got about maybe one third men, two thirds woman. Brien7 here, would have perhaps fifty per cent, maybe more men, um, and at times I‘ve had fifty per cent so it varies a bit, but many counsellors get about ten per cent men, 80 per cent woman so the notions about shame are actually drawn from working with women. [SI 4]


Name changed to preserve anonymity and reduce identifiability.


Shame: the ingenious quilt This suggests that a profitable area for further research might be in this area of gender differences and how those differences impact on, not only the seeking of treatment, but also shame-proneness versus shame-vulnerability, and whether or to what extent differences exist in the manifestation of shame issues.

Differences certainly exist where shame and guilt are concerned, and the literature revealed some considerable debate about the whether and what and how of the distinctions (B. Brown, 2008; Sabini & Silver, 2005; Tangney & Dearing, 2004; Tangney, Miller, Flicker, & Barlow, 1996). Three of the participants mentioned guilt directly or described guilt using different terminology, usually in the context of comparison with and differentiation from shame.

So whereas a person might be operating perfectly normally in the world with a burden of guilt, what you will see with someone who is carrying a huge burden of shame‌um, this person will very often just display a physical symptom that shows that they are struggling with being seen physically and experiencing a shame around that, that physical, er, their physical being as it exists in the eyes of somebody else. [SI 1]

For one participant the distinctions between shame and guilt held some theoretical interest but were not significant in practical terms:

Labelling you as a this or a that. That‘s shame-based, but attacking you for not picking up your clothes and for not, um, eating properly they distinguish as


Shame: the ingenious quilt guilt-based. But I‘ve never—in practice you don‘t bother with differentiating. You work with what the experience actually is. [SI 4]


So these are more theoretical differentiations. Some of them are helpful and some actually don‘t make any being with people. Yeah. So guilt, um, I guess I see guilt as to do with a highly over-active self-critic. Um, which would have been internalised by, um, people who matter to you growing up. But um, I also see the self-critic, I understand the self-critic in my mind is to do with um, an absence often of a warm nurturing wise wisdom around you. So instead of that—when that‘s missing a child will replace it with um, with the self-critic to try and take care of you. So, I see the self-critic is there about danger, it‘s there to protect you from being harmed or from being rejected. [SI 4]

However, one participant did speak about guilt in terms of shame, although they did not, as so many, from researchers to the illusive ―man [sic] on the street‖, do, conflate shame and guilt as synonymous:

And the other one I call Ethical Shame is that—which is maybe what the man is feeling, the ethical shame being ―My goodness, how could I have done that to someone I cared about,‖ so it‘s a breach of ethics. [SI 3]


Shame: the ingenious quilt This is the language of guilt, the ethically- and morally-definable transgression against a known social law, I did something wrong, as opposed to the internalised, excruciating conviction of shame that I AM something wrong (Bradshaw, 1987; Nicolosi, 2009; Tangney & Dearing, 2004).

These, then, were some of the theoretical issues evident in the researcher‘s analysis of the interview transcripts. The question remained, however: what did shame look like when it walked in off the street? what, in therapeutic terminology, were some of the ―presenting issues‖?


Presenting issues She said I don’t know if I’ve ever been good enough I’m a little bit rusty, and I think my head is caving in And I don’t know if I’ve ever been really loved By a hand that’s touched me, well I feel like something’s gonna give And I’m a little bit angry, well Rob Thomas Push

It seems that a time will come when the shame a person feels becomes overtly intrusive. Although other signs may exist, even be apparent to the person and possibly more so to the therapist, it is often a malaise described in general terms that leads to therapy and treatment:

Their experiences—their subject of experience is that they feel awful, that their—they feel terrible, but what they don‘t necessarily have is an understanding that this was inflicted upon them. Um, from the outside. They tend to assume that, ‗I feel awful and I am awful.‘ ... [SI 1]

The general statement of awfulness leads to further exploration of underlying issues: 70

Shame: the ingenious quilt ... and ―people hate me and people despise me because of my awfulness,‖ so they don‘t have any place to stand, to look at what happened. And that‘s why my way of working is to re-trace the history and to use the past and to investigate. To start to reveal that picture, that dynamic picture of when did you first learn to feel so bad about yourself. You see, and to ask that question is not just about dragging up the past it‘s about trying to build in a new perspective to see something for the first time, you know, to—and what we think of as the therapeutic effect of that is for the client to be able to articulate for the first time a story about how they came to be shamed. How they came to feel ashamed and, you know, the context in which this happened to them. That‘s a much bigger story than, ―I feel awful. I feel bad about myself.‖ That‘s a very intimate story that doesn‘t have much movement in it. So, a more critical story is ―How did this come to happen to me? How? And how could it have been any different?‖ That‘s the important element to that too. [SI 1]

One of the important observable issues in presentation of pathology is repetition:

Yes. Nearly always I find that whatever has happened to a person in their childhood of a nature that might be described as, you know, harmful, dysfunctional or traumatising, no matter what kind of trauma it is, that will nearly always be repeated or tend to repeat itself in the older life of the client. Um, so that‘s nearly always my—I would say that‘s almost a universal observation that the tendency for things to repeat are generationally. It certainly applies to shame as much as it does to anything else. I‘m just trying to think of an example. Perhaps an obvious example is bullying. The bullied


Shame: the ingenious quilt person becomes the bully. There‘s a lot of shaming involved in bullying. It‘s very physical. Bullying is a very physical thing, it usually focuses on physical attributes and so a person who has been bullied and shamed in that way will very often tend to repeat that with people who are close to them in their own families once they grow up and have their own families. [SI 1]

Repetition of shame and shaming behaviour patterns was also something that appeared in the context of childhood sexual abuse (CSA):

And, um, there is a shame attached to being an offender because I think, to be called a paedophile is kind of the new leprosy. It‘s the worst name in the worst position that a person can have put onto themselves. So there‘s a lot of shame about that and the fact that they have committed offences that can put them in that category. Um, but the healing process, which then gets them to take responsibility for their offending and to be less at risk actually deals—has to deal with the childhood shame. If that‘s not able to be, er, um, eradicated isn‘t the right word, ameliorated or lessoned such that they can actually come back into harmony with themselves, like, maybe forgive themselves or accept that part of themselves that‘s done something terribly wrong. Unless they can do that, they actually remain at risk of reoffending. [SI 2]

In this highly-specific area of CSA presenting issues were also fairly predictable:

Most people that come to see me are suicidal. They want to die. Escape from a terrible situation they‘ve found themselves in. That‘s—that‘s most of the men.


Shame: the ingenious quilt Um, most of the women are, er, disempowered in their lives. I‘m not saying the men aren‘t but the men are more actively suicidal as a rule and then, then their disempowerment can be worked on once they decide to live. Um, but the women are more kind of trapped in their shame and victimhood. Um, blaming themselves for the situation in which they‘ve found themselves. [SI 2]

This participant continued with the following crucial insights:

That‘s right. Self blame is a key concept. And of course they can‘t do anything else if it‘s childhood stuff because the ego-centricity of childhood means that if anything goes wrong, um, they don‘t have a concept of outside agency. They can‘t actually attribute the blame to the adult or the outside world, um, because they don‘t have an experience of that. That‘s why I often say to people, ―You can‘t actually recognise you‘ve been subject—a victim of child sexual abuse, until you‘re an adult.‖ You can know that you experienced things that you didn‘t like or that confused you or whatever, but you can‘t actually know what child sexual abuse is until you are an adult and realise that the things that you experienced weren‘t appropriate. So, consequently—and of course when we‘re born we assume we‘re the centre of everything, you know, and everything comes from us, like we cry and our mother‘s milk appears, etcetera, then we get older and realise that there‘s other people out there producing these things but those very important agents say to us, ―If you‘re good, good things will happen. If you‘re bad, bad things will happen‖. So if something bad happens the child‘s automatic assumption is ―I must have done something bad or I must be bad‖. [SI 2]


Shame: the ingenious quilt

Recognising the issue, however, was the first step towards healing:

Participant: ... yeah, ‗cause it‘s not conscious, it‘s an unconscious experiencing you know, and attributing self-blame to it. It‘s not a conscious attribution so until it, one can become aware and conscious then it‘s very difficult to address ... Interviewer: Yes. Participant: ... in fact, that‘s why offending actually is one process by which it can come to awareness. Like, it‘s often a way of telling a person this is what happened to you. So, for example, with women, often in adult life they get flashbacks to their childhood and that‘s the sign that they can then work through it ‗cause it‘s actually remerged. Um, with men, sometimes offending is the first indication that anybody gets that there was something like that in their life, because the men that are most at risk of offending are the ones that don‘t know they‘ve been abused. [SI 2]

As the first participant indicated, clients rarely use the word shame when talking about their issues. In the arena of domestic violence (DV) guilt was more likely to be an issue for men than shame, though for battered or otherwise-abused women the experience of being abused was unquestionably shaming.


Shame: the ingenious quilt Participant: So and in another case I think of when you say the word, where a young woman who, on a scale of severity of sexual abuse you would say nothing, but the meaning she attached to it was, it was a Catholic family, um, bad things don‘t happen in Catholic families, as a teenage girl her father, which she had never done before, you know, girl sitting on her dad‘s knee that sort of thing, touched her breasts, once and she was ―Oh‖ and then it happened twice and she never went near him since then and the other thing he used to do, as I remember, this was many years ago, er, would come into her bedroom unannounced, where you know, primary aged kids their bedroom doors are open. Once they get to teenagers they tend to shut their doors. Interviewer: Yes, yes. Participant: So, and what her conclusion from that was, er, this is a good family, bad things don‘t happen in this family. It‘s happened to me therefore I must be a bad person. Interviewer: I must be a bad person, yeah. Participant: That was the conclusion she came to which isn‘t called shame and thereafter for many years she thought, well whatever she got however she got treated by men, sort of what she came in about, was just what she deserved, she was a bad person. [SI 3]

The researcher received another surprise when one participant responded to a question asking about the presentation of shame by saying:


Shame: the ingenious quilt Er, well I don‘t see shame presented. Shame hides itself, it‘s of its nature, it‘s about hiding and disappearing… [SI 4]

However, the participant continued quickly:

so it might present in many ways really. But I guess I begin to wonder about if that‘s what‘s operating when people um, block, when they can‘t speak anymore, when they um, they get overwhelmed with affect or feeling. Er, when they can‘t look at you. Er ... When they put their hand to their forehead and hide their eyes like this. So, when there‘s any kind of hiding. Um, when there‘s any kind of switching going on; disassociation happening. I would associate shame with disassociation. [SI 4]

The researcher was unsure whether the participant had initially misunderstood the question. Nevertheless, the researcher realises that the question itself may have lacked clarity. The participant‘s response precisely reflected shame theory: ―shame hides itself‖; so logically no one would ―see‖ it in an obvious way. The participant, however, indicated clearly that they were attuned to the signs of shame‘s (hidden) presence:

I think one just intuitively works with what‘s there but I think the thing about shame is one finds oneself slowing right down, pulling out from trying to ask questions, stopping going with the content and slowing, pulling right back to not force, not push, not put anything in… [SI 4]


Shame: the ingenious quilt Of considerable importance was the theme that this participant‘s now introduced: the treatment and, possibly, healing of shame.


Therapy Primum non nocere8. Attributed to Hippocrates; probably coined by Dr Thomas Sydenham

The overtly-articulated therapies the participants used in their practices included psychodynamics, narrative therapy (the Dulwich Centre modality), and an eclectic approach that incorporated skill-sets and techniques from several other recognised modalities (for instance, CBT, Behaviourism, narrative story formation, depth psychology). In all cases, however, the researcher found that the guiding principles of praxis were closely-enough related to Person-Centred Therapy (PCT) as to be, in practical terms, indistinguishable from it.

One participant was clear beyond question that no shame-based client should experience shame in therapy:

Because this person has already suffered an invasion, an invasive injury, and so the first thing that would be on my mind is to establish trust and safety and to really make clear the separation between the two people in the room. In other words, um, if we think of shame as an attacking and invading kind of experience, um, it would be very important for someone suffering from a burden of shame or having a core of shame that they‘re not going to reexperience that in therapy; that a person is not going to be delving in and so


First (or, Above all), do no harm.


Shame: the ingenious quilt that‘s the first thing to establish; trust and safety and separateness. The other important element of the separateness I think is that in many ways what the shamed person needs in therapy is a new experience. They need a new experience of somebody looking at them and yet so, so, what I‘m going to be for that shamed person is I‘m going to be another person on the outside, I have my own set of eyes, I‘m looking at the person and they would be expecting a shaming type of experience. That‘s been their experience but when a person, especially someone who they might imagine is an authority figure or a fatherfigure or something, so this is where transference is an important element here, they might be expecting another shaming experience. They might lapse automatically back into that subject of anticipation of being shamed. [SI 1]

This participant expressed a beautiful and sensitive attitude of care:

they [the client] might just want to tell you that they feel helpless or hopeless, um, they might just want to tell you how bad it is and they might not be particularly hopeful at that point. They might just have nowhere else to go and what they want to do is they want to borrow from your hopefulness. So in that situation as a therapist, it is your job to be hopeful. They might be all out of hope. They might actually be in a stage of despair and therefore the person who is hopeful is the therapist. And you wouldn‘t necessarily say I‘m hopeful for you, even though you are not. You might say that but basically you‘ve just got to be hopeful and you‘ve got to convey that just through your manner and your constancy and your reliability. [SI 1]


Shame: the ingenious quilt Each participant in different ways expressed this same respectful attitude of hope and ―doing no harm‖. Hope was an important consideration for another participant:

Like I think—I guess I use the suicidality aspect because that is the most marked difference and all it might be is an intensity of shame, because usually the people that are like that have just been picked up for child internet pornography or child sexual abuse or something about which they‘re intensely, you know, they‘re devastated and they know that they‘ve let their families down, etcetera, and they‘ve always had this background intention that, ―If this ever comes to light I‘ll top myself‖. Then of course it comes to light so of course that‘s where they immediately go. ―I‘ll kill myself‖. Because they don‘t actually know of any other avenue of hope. That‘s when they usually get referred to me by whatever crisis line or police or whatever. And, um, that‘s when they get this glimmering of hope that there could be a different way forward that isn‘t totally destructive. [SI 2]

This participant expressed the theme slightly differently at the end of the interview:

I really am a fan of Erickson and his approach because what he says is if we don‘t succeed in that life-task between 18 months and 3 years of age, then we hit another failure experience in our lives later on, we come back and we‘ve got another opportunity to actually, um, deal with that. That‘s what I love about it. It‘s not—it‘s a never ending life work {{where ? 54:37}} we‘ve actually fallen into the pit of shame, um, and we pick ourselves up and carry on, and we fall again, that‘s not, that‘s not a failure, it‘s another opportunity to


Shame: the ingenious quilt actually do it differently which is how I regard offending. Is that if a person‘s been a victim and then they offend then the offending is the first sign of—well, not the first sign but it‘s a very clear sign that that earlier stuff has to be addressed and so it gives you that opportunity to address it where if you were blight—if you managed to escape offending just by accident, not getting into a situation where it popped up, you would still have an unresolved dilemma that you were unhealed of. [SI 2]

This participant had used a variety of techniques over the years in approaching both individual and group therapy, although they had now become ―integrated‖:

I used to [use a variety of approaches] but they‘re all integrated now into my approach. (laughing). But, um, er, the most common would be to help, er, people just follow their feelings, their physical sensations in their body and their feelings and also be to get them to recall um, childhood memories in a kind of narrative fashion. So experiential, narrative, um, occasionally I use um, cognitive behavioural techniques or rational and emotive therapy ways. Like if a person is in a state about something in the present then I will work in the present as well and not always go back um, to kind of um, unveil their negative self talk or say, for example, in talking with somebody about feeling shame in the present, I might go back and ask them to think about what‘s triggered it. What is the activating event and what‘s their way of talking about it. And, some of the ways that trigger the shame are, ―I should‘ve known better,‖ or ―There‘s something wrong with me that I didn‘t do this,‖ or ―This person has found me out‖. You know, so all sorts of self talk ... [SI 2]


Shame: the ingenious quilt By contrast, one participant was committed to Narrative Therapy:

my interest is narrative therapy, that‘s my, my passion if you like [SI 3]

One of the primary techniques involves asking questions to elicit counter-stories and affirm ―unique outcomes‖:

... so all this bringing out the things she did is the beginning of that story, wasn‘t okay with me, I didn‘t do anything to...‖ you know, and things of, I‘ve said to her, ―I wonder. How come there are two women in your house. One was an adult, one was an eight year old girl. Why do you think the man who abused you picked on you and not your mother?‖ She just laughed, ―Well, my mother would‘ve slapped him in the face‖. ―So do you think he deliberately chose an eight year old girl?‖ Even that has meaning, you see, like the grooming idea rather than her being flirtatious. So once you ask questions that start to change—without telling her this, she comes to this conclusion herself. Once they start to answer questions it changes the meaning of things, then they can start to change one wonderful occasion for me, and for her, once she became a little freer of the self-hate and the worthlessness, er, she used to say, ―But I feel dirty,‖ and she was referring to her genitalia. ―I just feel dirty‖. I said to her, ―I wonder if you think that it would be more appropriate if the people who did the dirtying, the people who did those things to you, I wonder if they should be feeling the dirtiness and not you, the one who it was done to?‖ And she came in the next week. She said, ―I don‘t feel dirty anymore‖. Again a question that changed—I didn‘t tell her this; I asked her the question.


Shame: the ingenious quilt Somehow you‘re left to carry the burden of what was done to you against your wishes. And they got off scot-free. Then she started to talk about anger. She said, ―I think I‘m turning into an angry woman‖. And then we had a conversation where she turned it into indignation and outrage, ―How dare they do this to me‖. So, um, this particular person talks about, er, life-changing questions and that one around the dirtiness was one that just was so profound in its ability to—for her to re-interpret—for her to re-interpret the meaning of things. She could‘ve said, ―No. No, I‘m just...‖, but she didn‘t. She sort of was able to put it out there; ―They‘re the ones who should be feeling dirty because they did it to me‖. And somehow for her that freed her. [SI 3]

Again, the participant shows considerable care and respect for the client. This is not to suggest that any of the participants were unable or unwilling to confront or challenge clients when necessary. Narrative Therapy itself challenges lifeworlds that clients have come to regard as ―normalised‖ (for them) even though these lifeworlds may inherently be painful and pathological. One participant spoke about guiding clients‘ thinking using perhaps more traditional techniques:

You know, so, challenging irrational beliefs is another one I use. Teaching people how to be assertive rather than aggressive ... [SI 2]

For another participant their own assertive style with resistant clients involved

meet[ing] them where they‘re at. So they will benefit from concrete plans, concrete advice and a more of a re-parenting in the sense of being a wise, sane


Shame: the ingenious quilt mind that they can borrow. And I think some of the domestic violence counsellors do wonderful work over years, it takes years and years, to have any hope of an impact. But, really I think, um, those who cannot hang in to a counselling relationship – counselling is not for the whole population. [SI 4]

This acknowledgement that ―counselling is not for the whole population‖ found an echo in comments another participant made:

I think—I think—it‘s a philosophical decision that every human being is treatable. It doesn‘t mean every human being will be able to be treated for what their problem is. [SI 2]


we‘re not clever enough or because we don‘t actually have the right kind of understandings of what‘s a good way of treating, we choose, it doesn‘t happen, you know. But I do have a philosophical and practical position that says there is hope of change and we have to address that and make it available if we want to improve society or protect children, um, and if we don‘t we‘re responsible for the fact that there‘s not been a change. [SI 2]

Nevertheless, for those seeking help who are struggling with shame, one participant was clear about what counselling needed to provide:


Shame: the ingenious quilt I think one just intuitively works with what‘s there but I think the thing about shame is one finds oneself slowing right down, pulling out from trying to ask questions, stopping going with the content and slowing, pulling right back to not force, not push, not put anything in. So, I find myself working very gently, not um, wanting to go anywhere. So, I‘m…I‘m tuning, attuning more to what the person can tolerate and what‘s okay and what‘s not okay. So I find myself asking for a lot more permission. ―Is it okay if I ask this?‖ Or ―Is it okay if we do that?‖ ―Would it be okay to just sit quietly for a while?‖ So, a lot more of that approach with shame. [SI 4]

This participant‘s view on healing shame was almost Zen-like:

I don‘t think there is any way of fixing shame itself or—and I would—I don‘t even have in my mind a goal to remove it. My goal is more to respect it rather than to move it or change it. [SI 4]


It‘s like to come alongside this horrific awful, experience. Quite apart from the thing that caused it, is the experience of shame is an overwhelming experience. [SI 4]



Shame: the ingenious quilt I think—I don‘t—my goal is not to get rid of shame. It‘s actually, um, it‘s really to approach what has given rise to that with compassion and gentleness and understanding and that frequently dissolves the experience the person can move beyond the shame but the vulnerability to shame remains. It‘s very hardwired, especially if it‘s happened under five years old in the shaping of the personality. [SI 4]

And in the end, in its way echoing the words of the first participant‘s example, this participant ended with this poignant statement of belief:

I think the value of psychotherapy and counselling is that you have the assistance of another who is warm and um, on your side, um, to wonder and explore some of the events and ways one thinks about and feels about the events on one‘s life. Um, that process develops a capacity for wondering, observing with kindness. [SI 4]

And that

…internalises that capacity and that‘s, I think, the purpose of therapy, to develop that. So you borrow your therapist‘s interest, unfailing presence and warmth and curiosity to assist you to differentiate some of the snowball that‘s inside into at least smaller snowballs and then see that this one‘s different to that one. So, further and further differentiation. We can only get that with observing self. Some people can‘t do that and it‘s not going to be possible in


Shame: the ingenious quilt their lifetime to develop that so there are some people who do not have a reflective space. [SI 4]

Because they

have never had a relationship where they‘ve been held in the mind of another. [SI 4]



The participants who agreed to be interviewed for this study came from different backgrounds, with different theoretical perspectives underpinning their praxis. One was relatively ―young‖ in practice, another had practised for four decades. All spoke with considerable authority about their professional practice and about the issue of shame as they experienced it as psychotherapists. What was apparent was that they were all committed to helping their clients using the tools and techniques with which they, as practitioners, worked most effectively, and although modality played some part in their thinking, and counselling and psychotherapeutic ethic, each was less concerned with theoretical positions than with helping clients in need. This is not to suggest that any were disdainful of theoretical principles: their individual and combined knowledge clearly indicated that the participants were conversant with shame issues. However, praxis was the dominant concern, and each participant was able to demonstrate an informed and respectful professional approach.


Shame: the ingenious quilt PART 5:


Translators and theologians like to use the word difficult when describing passages of scripture that are particularly demanding, either because they contain linguistic ambiguities, or because the content of the text might offend comfortable beliefs or longstanding doctrine. The researcher was happily surprised that the participants in this study on the relationship between the affect shame and the presenting issues of those who came seeking therapy were not only conversant with shame theory but willing and able to articulate their views and discuss their practices.

Because shame is undeniably a very difficult affect, an emotion about which people would prefer to remain silent (B. Brown, 2005; 2008).

However, the study has revealed that it is possible to talk intelligently and with authority about a subject whose nature is such that the danger is ever-present that issues of transference and countertransference can create at best uncomfortable feelings in the therapy room. To some extent shame has the notorious reputation for osmotically dragging to the surface the therapist‘s own shame-horror. This is one of the reasons that few people, according to Brown (2008), wish to talk about shame.

Most of the data collected and analysed was not, ultimately, surprising. The major issues shame theory advances were present – abuse in all its grotesque shapes and polychromatic muddiness, familial dysfunction, the propensity for the human being to smell blood and savage and devour with scant mercy. Perhaps the researcher was too optimistic in thinking that lesser-known issues might rise to be discussed. Eating disorders and addiction did not enter the arena; anger was present, but hid beyond the boundary ropes; so too bullying.


Shame: the ingenious quilt Likewise the wider issue of family systems, despite the appearance of dysfunction, which nevertheless alighted on the usual suspects (Bradshaw, 1987; Engel, 2006).

Was the study worth doing? Unquestionably!

The researcher continues to believe that shame is an area that remains under-studied and that the psychological community in the widest sense of the term will benefit from further research and insight. Shame research seems to have proceeded in something of a sine-wave fashion, with a slow Freudian beginning, little attention for decades, then an upward wave of interest in the 1970s and 1980s. Names such as Helen Block Lewis, Donald Nathanson, and Gershen Kaufman come to mind. Then another trough, short-lived thanks to the vigorous and prolific emergence of June Price Tangney (and associates). More recently the twilit world between academic and self-help has seen the appearance of Brené Brown, who is medialiterate, knows how to ―do‖ qualitative research, and is easily found on YouTube.

Nevertheless, several areas of potential further research and study persist. Emerging from the results of this study, the following suggestions seem pertinent:

Shame and the imagination. How do shame and the imagination relate to one another? What is the defining role of the imagination in creating shame-based persons and scenarios?

Neurological perspectives. Certainly some study has occurred in this area. Cozolino, Siegel and Badenoch come to mind. More would be welcome, especially as knowledge of the neurological has the potential to be of great clinical assistance.


Shame: the ingenious quilt 

Gender issues. Perhaps a somewhat hoary suggestion. However, it remains unclear and ambiguous what differences exist between the female and male reception of shame. How do notional differences affect treatment options, if at all? What developmental issues should therapists be aware of?

It may be that ultimately that the best treatment for shame is also a wider community education programme. Let shame be the subject of discussion. Let those who, like this researcher, are shame-based speak openly about the affect and its effect. Dispel the persistent ignorance that conflates shame and guilt, and proffer wiser and sounder solutions to the maddening drum-beat demanding the imposition of shame on fellow human creatures.


Shame: the ingenious quilt PART 6:


The study of shame gives the researcher a feeling somewhat akin to the affectional equivalent of the opening salvo of A tale of two cities: much is known about shame; little seems to be understood about shame. At least one theorist, attentive to other concerns, has advanced the notion that shame underpins all or most psychic pathologies (Resnick, 1997), and Holloway (2005) quotes Tangney‘s observation that ―shame is associated with virtually every DSM disorder‖ (p. 22). Resnick‘s view is a little jaundiced: the therapeutic tool is a hammer, and every pathology looks like a nail. He is suggesting it is necessary to be more discerning about the therapeutic uncovering of shame, that perhaps other pathologies warrant attention.

It is an issue worth attending to. But it does not mean that shame should cease to be the focus of intelligent research and discussion. Discernment is a wise road down which to travel, but the participants in this study demonstrated that wisdom.

The researcher concludes that judgement continues to be necessary in the field, and that practitioners will continue to be attentive to their clients on a case-by-case basis. None of the participants in this study conveyed the impression that they would simply launch into a therapy without first gathering every piece of relevant and available evidence from their clients.

Whatever DSM may say and whatever may be Dr Resnick‘s fears, the researcher remains confident of at least two outcomes: shame is worth the effort of continuing and expanding study; practitioners will and do attend to their clients, not by elevating theory beyond practice, but by discerning, caring, and, to use the poignant and elegant phrase of participant no. 4, holding each client in their mind.


Shame: the ingenious quilt REFERENCES Ashworth, P. (2008). Conceptual foundations of qualitative psychology. In J. A. Smith (Ed.), Qualitative psychology: a practical guide to research methods (2nd ed.) (pp. 4-25). Los Angeles: Sage. Badenoch, B. (2008). Being a brain-wise therapist: a practical guide to interpersonal neurobiology. New York: W. W. Norton & Company. Biggerstaff, D., & Thompson, A. R. (2008). Interpretive phenomenological analysis (IPA): a qualitative methodology of choice in healthcare research. Qualitative Research in Psychology, 5(3), 214-224. Blow, A. J., Sprenkle, D. H., & Davis, S. D. (2007). Is who delivers the treatment more important than the treatment itself? The role of the therapist in common factors. Journal of Marital and Family Therapy, 33(3), 298-317. Bowlby, J. (2005). The making and breaking of affectional bonds. London: Routledge. Bowler, J. M. (1997). Shame: a primary root of resistance to movement in direction. Presence: An International Journal of Spiritual Direction 3(3), 25-33. Boyd, C. (2007). Attachment theory and sexual offending: critical considerations. Developing Practice, 19(Winter/Spring), 44-53. Bradshaw, J. (1988). Healing the shame that binds you. Deerfield Beach, Florida: Health Communications, Inc. Bromberg, P. M. (1998). Standing in the spaces: essays on clinical process, trauma, and dissociation. New York: Psychology Press. Bromberg, P. M. (2001). Treating patients with symptoms – and symptoms with patience: reflections on shame, dissociation, and eating disorders. Psychoanalytic Dialogues, 11(6), 891-912. Brown, B. (2005, March 5). Dr. Joyce Brothers on Shame: Good Intentions, Bad Advice.


Shame: the ingenious quilt Retrieved March 23, 2011, from Brown, B. (2008). I thought it was just me (but it isn’t): telling the truth about perfectionism, inadequacy, and power. New York: Gotham Books. Brown, B. (2010, October 6). The power of vulnerability [Video web log]. Retrieved from Brown, J. (2004). Shame and domestic violence: treatment perspectives for perpetrators from self psychology and affect theory. Sexual and Relationship Therapy, 19(1), 39-56. Buchbinder, E., & Eisikovits, Z. (2003). Battered women‘s entrapment in shame: a phenomenological study. American Journal of Orthopsychiatry, 73(4), 355-366. Carroll, F. (2009). The pitchfork princess. Transforming the torment of shame. Interamerican Journal of Psychology, 43(2), 260-267. Choma, B. L., Shove, C., Busseri, M. A., Sadava, S. W., & Hosker, A. (2009). Assessing the role of body image coping strategies as mediators or moderators of the links between self-objectification, body shame, and well-being. Sex Roles, 61, 699-713. Claesson, K. & Sohlberg, S. (2002). Internalized shame and early interactions characterized by indifference, abandonment and rejection: replicated findings. Clinical Psychology and Psychotherapy, 9, 227-284. Cozolino, L. (2002). The neuroscience of psychotherapy: building and rebuilding the human brain. New York: W. W. Norton & Company. Cozolino, L. (2006). The neuroscience of human relationships: attachment and the developing social brain. New York: W. W. Norton & Company. Creamer, T. L., & Liddle, B. J. (2005). Secondary traumatic stress among disaster mental health workers responding to the September 11 attack. Journal of Traumatic Stress, 18(1), 89-96.


Shame: the ingenious quilt de Hooge, I. E., Zeelenberg, M., & Breugelmans, S. M. (2010). Restore and protect motivations following shame. Cognition and Emotion, 24(1), 111-127. Draper, M. (2011, September 16). Sailor treated rape victim like prop. The West Australian. Retrieved September 16, 2011, from Elison, J., Lennon, R., & Pulos, S. (2006). Investigating the Compass of Shame: the development of the Compass of Shame Scale. Social Behavior and Personality, 34(3), 221-238. Elison, J., Pulos, S., & Lennon, R. (2006). Shame-focused coping: an empirical study of the Compass of Shame. Social Behavior and Personality, 34(2), 161-168. Engel, B. (2006). Healing your emotional self: a powerful program to help you raise your self-esteem, quiet your inner critic, and overcome your shame. New Jersey: Wiley. Erikson, E. H. (1995). Childhood and society. London: Vintage. Erskine, R. G. (1995). A Gestalt therapy approach to shame and self-righteousness: theory and methods. British Gestalt Journal, 4(2), 108-117. Farber, B. A., Khurgin-Bott, R., & Feldman, S. (2009). The benefits and risks of patient self disclosure in the psychotherapy of women with a history of childhood sexual abuse. Psychotherapy Theory, Research, Practice, Training, 46(1), 52-67. Feiring, C., Simon, V. A., & Cleland, C. M. (2009). Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression. Journal of Consulting and Clinical Psychology, 77(1), 127-137. Feiring, C., & Taska, L. S. (2005). The persistence of shame following sexual abuse: a longitudinal look at risk and recovery. Child Maltreatment, 10(4), 337-349. Felblinger, D. M. (2008). Incivility and bullying in the workplace and nurses‘ shame responses. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 37, 234-242.


Shame: the ingenious quilt Fossum, M. A. & Mason, M. J. (1986). Facing shame: families in recovery. New York: W. W. Norton & Company. Gilbert, P. (2003). Evolution, social roles and the differences in shame and guilt. Social Research: An International Quarterly, 70(4), 1205-1230. Gilbert, P., Baldwin, M. W., Irons, C., Baccus, J. R., & Palmer, M. (2006). Self-criticism and self-warmth: an imagery study exploring their relation to depression. Journal of Cognitive Psychotherapy: An International Quarterly, 20(2), 183-200. Gilbert, P. & Irons, C. (2004). A pilot exploration of the use of compassionate images in a group of self-critical people. Memory, 12(4), 507-516. Gilbert, P. & Proctor, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13, 353-379. Giorgi, A., & Giorgi, B. (2008). Phenomenology. In J. A. Smith (Ed.), Qualitative psychology: a practical guide to research methods (2nd ed.) (pp. 26-52). Los Angeles: Sage. Goldberg, C. (1990). The role of existential shame in the healing endeavour. Psychotherapy, 27(4), 591-599. Goodwin, J. M., Wilson, N., & Connell, V. (1992). Natural history of severe symptoms in borderline women treated in an incest group. Dissociation, 5(4), 221-226. Gray, R. (2009). The self and shame: barriers to using a person-centred framework when counselling in alcohol and other drug settings. Paper presented at the 5th International Biennial SELF Research Conference 2009, Dubai, SELF Research Centre, Oxford University, United Kingdom. Greenberg, L. (2008). Emotion and cognition in psychotherapy: the transforming power of affect. Canadian Psychology, 49(1), 49-59.


Shame: the ingenious quilt Hansen, B. (2006). Shame and anger: the criticism connection. Washington, D.C.: Change for Good Press. Harder, A. F. (2009). The developmental stages of Erik Erikson. (Rev. ed.). Retrieved October 27th , 2011, from Learning Place Web site: Harman, R., & Lee, D. (2010). The role of shame and self-critical thinking in the development and maintenance of current threat in post-traumatic stress disorder. Clinical Psychology and Psychotherapy, 17, 13-24. Heller, A. (2003). Five approaches to the phenomenon of shame. Social Research, 70(4), 1015-1030. Herman, J. L. (1992). Trauma and recovery. New York: Basic Books. Herman, J. L. (2007, September). Shattered shames states and their repair. (Final Draft). The John Bowlby Memorial Lecture, Centenary John Bowlby Memorial Conference, 1907-2007, March 10, 2007, London. Holloway, J. D. (2005, November). Guilt can do good. Monitor, 36(10), 22. Retrieved October 5th, 2011, from Fmonitor%2Fnov05%2Fguilt.aspx&q=Shame&c=ps&ss=webLink&p=Convera&fr=t rue&ds=80&srid=8 Johnson, A. (2006). Healing shame. The Humanistic Psychologist, 34(3), 223-242. Jordan, J. V. (2001). A relational-cultural model: healing through mutual empathy. Bulletin of the Menninger Clinic, 65(1)92-103. Kaufman, G. (1992). Shame: the power of caring (3rd rev. and expanded ed.). Rochester, Vermont: Schenkman Books, Inc. Keith, L., Gillanders, D., & Simpson, S. (2009). An exploration of the main sources of shame


Shame: the ingenious quilt in an eating-disordered population. Clinical Psychology and Psychotherapy, 16, 317327. Kurtz, E. (2007). Shame & guilt (2nd rev. and updated ed.). New York: iUniverse, Inc. Lansky, M. R. (2009). Forgiveness as the working through of splitting. Psychoanalytic Enquiry, 29, 374-385. Lewis, M. (1995). Shame: the exposed self. New York: The Free Press. Lewis, M. (2003). The role of the self in shame. Social Research 70(4), 1181-1204. Lickel, B., Schmader, T., Curtis, M., Scarnier, M., & Ames, D. R. (2005). Vicarious shame and guilt. Group Process & Intergroup Relations, 8(2), 145-157. Lisak, D. (1994). The psychological impact of sexual abuse: content analysis of interviews with male survivors. Journal of traumatic stress, 7(4), 525-548. Loftus, S. F. (2006). Language in clinical reasoning: learning and using the language of collective clinical decision making. Ph.D. thesis, University of Sydney, Sydney, N.S.W., Australia. MacKinnon, L. (2008). Hurting without hitting: non-physical contact forms of abuse. Stakeholder Paper 4, Australian Domestic & Family Violence Clearinghouse, University of New South Wales. Marmarosh, C. L., Whipple, R. Schettler, M., Pinhas, S., Wolf, J., & Sayit, S. (2009). Adult attachment styles and group psychotherapy attitudes. Group Dynamics: Theory, Research, and Practice, 13(4), 255-265. McKay, K. M., Hill, M. S., Freedman, S. R., & Enright, R. D. (2007). Towards a feminist empowerment model of forgiveness psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 44(1), 14-29. Middleton-Moz, J. (1990). Shame and guilt: the masters of disguise. Deerfield Beach, Florida: Health Communications, Inc.


Shame: the ingenious quilt Miller, A. (1987). The drama of being a child and the search for true self. London: Virago Press. Miller, M. M., & Ivey, D. C. (2006). Spirituality, gender and supervisory style in supervision. Contemporary Family Therapy, 28, 323-337. Miller-Keane encyclopedia and dictionary of medicine, nursing, and allied health. (7th ed.). (2003). [S. l.]: Saunders. Mills, R. (2005). Taking stock of the developmental literature on shame. Developmental Review 25, 26-63. Mills, R. S. L., Arbeau, K. A., Lall, D. I. K., & De Jaeger, A. E. (2010). Parenting and child characteristics in the prediction of shame in early and middle childhood. Merrill Palmer Quarterly, 56(4), 500-528. Morrison, A. (1987). The eye turned inward: shame and the self. In D. L. Nathanson (Ed.), The many faces of shame. New York: The Guilford Press. Mosby's medical dictionary. (8th ed.). (2009). [S. l.]: Elsevier.

Nathanson, D. L. (1987). A timetable for shame. In D. L. Nathanson (Ed.), The many faces of shame. New York: The Guilford Press. Nathanson, D. L. (1992). Shame and pride: affect, sex, and the birth of the self. New York: W. W. Norton & Company. Neuman, W. L. (2006). Social research methods: qualitative and quantitative approaches (6th ed.). Boston: Pearson. Nicolosi, J. J. (2009) Shame and attachment loss: the practical work of reparative therapy. Downers Grove, Illinois: IVP Academic. Osherson, S. & Krugman, S. (1990). Men, shame, and psychotherapy. Psychotherapy, 27(3), 327-339. Pascual-Leone, A. & Greenberg, L. S. (2007). Emotional processing in experiential therapy:


Shame: the ingenious quilt why ―the only way out is through‖. Journal of Consulting and Clinical Psychology, 75(6), 875-887. Potter-Efron, R. & Potter-Efron, P. (1989). Letting go of shame: understanding how shame affects your life. New York: Harper/Hazelden. Rahm, G. B., Renck, B., & Ringsberg, K. C. (2006). ‗Disgust, disgust beyond description‘ – shame cues to detect shame in disguise, in interviews with women who were sexually abused during childhood. Journal of Psychiatric and Mental Health Nursing, 13, 100109. Rangganadhan, A. R. & Todorov, N. (2010). Personality and self-forgiveness: the roles of shame, guilt, empathy and conciliatory behavior. Journal of Social and Clinical Psychology, 29(1), 1-22. Reid, R. C., Harper, J. M., & Anderson, E. H. (2009). Coping strategies used by hypersexual patients to defend against the painful effects of shame. Clinical Psychology and Psychotherapy, 16, 125-138. Resnick, R. W. (1997). The ―recursive loop‖ of shame: an alternate Gestalt therapy viewpoint. Gestalt Review, 1(3), 256-269. Ryan, T. (2008). Healthy shame? An Interchange between Elspeth Probyn and Thomas Aquinas. Australian eJournal of Theology, 12(1), 1-18. Sabini, J. & Silver, M. (2005). Why emotion names and experiences don‘t neatly pair. Psychological Inquiry, 16(1), 1-10. Sable, P. (2004). Attachment, ethology and adult psychotherapy. Attachment & Human Development 6(1), 3-19. Scarnier, M., Schmader, T., & Lickel, B. (2009). Parental shame and guilt: distinguishing emotional responses to a child‘s wrongdoings. Personal Relationships, 16, 205-220. Schilling, E. A., Aseltine, R. H., Jr, & Gore, S. (2007). Young women‘s social and


Shame: the ingenious quilt occupational development and mental health in the aftermath of child sexual abuse. American Journal of Community Psychology, 40, 109-124. Schooler, D., Ward, L. M., Merriwether, A., & Caruthers, A. S. (2005). Cycles of shame: body shame and sexual decision-making. The Journal of Sex Research, 42(4), 324334. Siebold, C. (2008). Shame, the affective side of secrets: commentary on Barth‘s hidden eating disorders. Clinical Social Work Journal, 36, 367-371. Skårderud, F. (2007). Shame and pride in anorexia nervosa: a qualitative descriptive study. European Eating Disorders Review, 15, 81-97. Smith, J. A. (2008). Introduction. In J. A. Smith (Ed.), Qualitative psychology: a practical guide to research methods (2nd ed.) (pp. 1-3). Los Angeles: Sage. Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretive phenomenological analysis: theory, method and research. Los Angeles: Sage. Smith, J. A., & Osborn, M. (2008). Interpretive phenomenological analysis. In J. A. Smith (Ed.), Qualitative psychology: a practical guide to research methods (2nd ed.) (pp. 53-80). Los Angeles: Sage. Sohlberg, S., Claesson, K., & Birgegard, A. (2003). Memories of mother, complementarity and shame: predicting response to subliminal stimulation with ―Mommy and I are one‖. Scandinavian Journal of Psychology, 44, 339-346. Sorotzkin, B. (1985). The quest for perfection: avoiding guilt or avoiding shame? Psychotherapy, 22(3), 564-571. Stiles, P. (2008). The negative side of motivation: the role of shame. Working paper, Judge Business School, University of Cambridge. Tangney, J. P. (1991). Moral affect: the good, the bad, and the ugly. Journal of Personality and Social Psychology, 61(4), 598-607.


Shame: the ingenious quilt Tangney, J. P. & Dearing, R. L. (2004). Shame and guilt. New York: The Guilford Press. Tangney, J. P., Mashek, D., & Stuewig, J. (2005). Shame, guilt, and embarrassment: will the real emotion please stand up? Psychological Inquiry, 6(1), 44-48. Tangney, J. P., Miller, R. S., Flicker, L., & Barlow, D. H. (1996). Are shame, guilt, and embarrassment distinct emotions? Journal of Personality and Social Psychology, 70(6), 1256-1269. Tangney, J. P., Wagner, P. E., Hill-Barlow, D., Marschall, D. E., Gramzow, R. (1996). Relation of shame and guilt to constructive versus destructive responses to anger across the lifespan. Journal of Personality and Social Psychology, 70(4), 797-809. Tomkins, S. (1963). Affect, imagery, consciousness: Volume II. The negative affects. New York: Springer Publishing Company, Inc. Valerio, P. & Lepper, G. (2009). Sorrow, shame, and self-esteem: perceptions of self and others in groups for women survivors of child sexual abuse. Psychoanalytic Psychotherapy, 23(2), 136-153. Vanheule, S. , Desmet, M., Meganck, R., and Bogaerts, S. (2007). Alexithymia and interpersonal problems. Journal of Clinical Psychology, 63(1), 109-117. Wei, M., Shaffer, P. A., Young, S. K., & Zakalik, R. A. (2005). Adult attachment, shame, depression, and loneliness: the mediation role of basic psychological needs satisfaction. Journal of Counseling Psychology, 52(4), 591-601. Wheeler, G. (1997). Self and shame: a Gestalt approach. Gestalt Review, 1(3), 221-244. Willig, C. (2001). Introducing qualitative research in psychology: adventures in theory and method. Buckingham: Open University Press. Wills, S. M. & Goodwin, J. M. (1996). Recognizing bipolar illness in patients with dissociative identity disorder. Dissociation, 9(2), 104-109. Wright, K., Gudjonsson, G. H., & Young, S. (2008). An investigation of the relationship


Shame: the ingenious quilt between anger and offence-related shame and guilt. Psychology, Crime & Law, 14(5), 415-423. Yahaya, A. H. (2006). Theory of moral development. Universiti Teknologi Malaysia Institutional Repository. Retrieved, September 26, 2011, from . Yardley, L. (2008). Demonstrating validity in qualitative psychology. In J. A. Smith (Ed.), Qualitative psychology: a practical guide to research methods (2nd ed.) (pp. 235-251). Los Angeles: Sage. Young, J. E. & Klosko, J. S. (1994). Reinventing your life: the breakthrough program to end negative behaviour…and feel great again. New York: Plume.




INFORMED CONSENT FORM I, (participant’s name) _________________________________hereby agree to being a participant in the above research project.  I have read and understood the Information Sheet about this project and any questions have been answered to my satisfaction.  I understand that I may withdraw from participating in the project at any time without prejudice.  I understand that all information gathered by the researcher will be treated as strictly confidential, except in instances of legal requirements such as court subpoenas, freedom of information requests, or mandated reporting by some professionals.  Whilst the research involves small sample sizes I understand that a code will be ascribed to all participants to ensure that the risk of identification is minimised.  I understand that the protocol adopted by the University Of Notre Dame Australia Human Research Ethics Committee for the protection of privacy will be adhered to and relevant sections of the Privacy Act are available at  I agree that any research data gathered for the study may be published provided my name or other identifying information is not disclosed.






If participants have any complaint regarding the manner in which a research project is conducted, it should be directed to the Executive Officer of the Human Research Ethics Committee, Research Office, The University of Notre Dame Australia, PO Box 1225 Fremantle WA 6959, phone (08) 9433 0943.



INFORMATION SHEET Dear potential participant, My name is .................... I am a student at The University of Notre Dame Australia and am enrolled in a Master of Counselling degree. As part of my course I need to complete a research project. The title of the project is……………………………………………. My research concerns………………………... ……………………………………………………………………………………………………………………………… The purpose of the study is to ………………………………………………………………………………………….. Participants will take part in a 50-60 minute tape-recorded interview. Information collected during the interview will be strictly confidential. This confidence will only be broken in the instance of legal requirements such as court subpoenas, freedom of information requests or mandated reporting by some professionals. To protect the anonymity of participants in a project with a small sample size, a code will be ascribed to each of the participants to minimise the risk of identification. The protocol adopted by the University of Notre Dame Australia Human Research Ethics Committee for the protection of privacy will be adhered to and relevant sections of the Privacy Act are available at hppt:/www/ You will be offered a transcript of the interview, and I would be grateful if you would comment on whether you believe we have captured your experience. Before the interview I will ask you to sign a consent form. You may withdraw from the project at any time. Data collected will be stored securely in the University’s School of Arts & Sciences for five years. No identifying information will be used and the results from the study will be made freely available to all participants. Due to the sensitive nature of this issue, the interview may raise some difficult feelings for you. If this happens I will make sure that support is available for you if you desire it. You will be provided with relevant counselling information at the interview and contacted by the researcher one week afterwards. The Human Research Ethics Committee of the University of Notre Dame Australia has approved the study. Professor Martin Philpott of the School of Arts & Sciences is supervising the project. If you have any queries regarding the research, please contact me directly or Professor Philpott by phone (08) 99433 0218, or by email at I thank you for your consideration and hope you will agree to participate in this research project.

Yours sincerely,

.............................. Tel: (08) ................


If participants have any complaint regarding the manner in which a research project is conducted, it may be given to the researcher or, alternatively, to the Provost, The University of Notre Dame Australia, PO Box 1225 Fremantle WA 6959, phone (08) 9433 0941.




What do you understand by “shame”? How common is it for clients to present with shame?

In your view, what is the difference between healthy shame and toxic shame?

To what extent do your clients recognise shame as a therapeutic issue for them? How is shame manifested by clients?

If you are treating a client’s shame as a significant therapeutic issue, what strategies or therapies do you use?

How would your therapy approach differ if shame is a peripheral issue for clients? How would your approach differ from working with clients who are not shamebased?

In your experience, what are some of the ways clients try to mask or hide their shame?

What is it, in your view, that helps resolve issues of shame?


Shame: the ingenious quilt LIST OF TABLES

Table 1: Participants

Table 2: Themes and sub-themes


Shame: the ingenious quilt  
Shame: the ingenious quilt  

A study of the relationship between shame and the presenting issues of those seeking therapy.