The purpose of this article is to help therapists on both sides of the supervision dyad have a better understanding of shame and its defenses. In order to elucidate the inevitable shame that arises in supervision, this article first describes the nature of shame, beginning with its early manifestations in interpersonal relationships with primary care givers. It also includes a short section on the adaptive nature of shame. Because individuals develop characteristic ways of coping with it, shame may be concealed from oneself and others through withdrawal, avoidance, attack on self, and attack on others. These characteristic reactions to shame are discussed in detail because they influence how shame is manifested. Four vignettes illustrate how each defensive reaction may be manifested in supervision, and suggestions for minimizing the adverse impact of shame are proffered. Psychotherapy supervision stimulates shame, yet the experience of shame rarely is addressedThe author gratefully acknowledges Dr. Ed Smith for his helpful comments.

Shame is a universal experience felt by patients and therapists alike. Yet, the experience of shame, with its profound sense of inadequacy and worthlessness, is anathema to the competent and compassionate self-image of most therapists. In order to help therapists understand their own shame and their countertransference identifications to patient shame, this article first describes the nature of shame, its developmental progression within interpersonal relationships, and the defenses commonly employed to cope with shame. Because the experience of shame involves the activation of devalued and devaluing internal representations, therapists may develop concordant or complementary countertransference identifications. These countertransference identifications are influenced further by the patient's primary reaction to shame, which includes withdrawal, attacks on self, avoidance, and attacks on others. Each of these reflects a habitual reaction to shame that is displayed in the patienttherapist relationship. The author gratefully acknowledges his colleague, Peter Kahn, M.S., for his helpful comments and suggestions.

Gift giving is a significant interpersonal event that has received relatively little attention in the psychotherapy literature, in spite of the fact that patients do give gifts to their therapists. Therapists' discomfort, uncertainty, or inexperience interfere with their ability to understand the meaning of a patient's gift and to provide a therapeutic response to it. Therapists' conviction, either to interpret all gift-giving behavior or to accept all gifts, also may limit their ability to understand the patient's subjective perspective. With a theoretical foundation in relational concepts, this article describes an approach in which both supportive and interpretive interventions are used to help patients address the organizing principles that give meaning to their experiences. The therapeutic value of supportive interventions such as gift acceptance, positive emotional responsiveness, and naming and describing are presented. Interpretations are used in this approach when gifts reflect a desire for reparation, displacement, and the projective identification of ingratiation.The author gratefully acknowledges his colleagues Marcus Flathman, PsyD, and Ed Smith, MD, for their helpful comments.

No abstract

No abstract