Derailed by a Blush: The Role of Shame in Couples Therapy

ABSTRACT

This paper explores the thesis that individual, collective and iatrogenic shame might be the unacknowledged elephant in the room in couples therapy. A number of examples are cited of couples treatment where shame is either ignored or unintentionally encouraged. Reference is made to the author’s earlier work (Shaddock, 1998, 2000) that cites shame, along with fears of abandonment and intrusion, as a powerful unconscious organizer of relationships. A discussion of the nonverbal origins of shame cites a consensus that it originates in the toddler phase, particularly in regards to derailments in the interpersonal regulation of states of heightened arousal. Attention is paid to the way couples’ nonverbal communication can repeat or restimulate these mirroring failures. The paper then turns to an exploration of shame that is iatrogenic in the couples treatment process, in which telling or emphasizing the right way to relate or communicate ignores the shame inducing message that the couple is doing things the wrong way. Another source of shame in the treatment comes from the therapist adopting an expert or all-knowing attitude. The paper concludes with a case example of a couple whose conflict centered around how the wife refused to wear clothes that exposed her body. The key to the treatment was understanding the husband’s shame as well as the wife’s.

KEYWORDS:

• Shame
• relationships
• iatrogenic shame
• non-verbal communication

Disclosure statement

No potential conflict of interest was reported by the author(s).

Patient anonymization statement

Potentially personally identifying information presented in this article that relates directly or indirectly to an individual, or individuals, has been changed to disguise and safeguard the confidentiality, privacy and data protection rights of those concerned, in accordance with the journal’s anonymization policy.

Notes

¹ The protocol for Dr. Beebe’s analysis was as follows: I would select an approximately 30 second piece of a videotaped session, then cut it into still slides, approximately one second apart. The slides were sent without any context or history. Dr. Beebe and her advanced study group would then analyze these slides using the techniques they use to analyze moment to moment split screen infant/caregiver interactions, such as face to face gaze, head orientation, facial affect, postural orientation (loom, etc.). As in the mother/infant research, the analysis revealed an unseen world of non-verbal interactions.

Additional information

Notes on contributors

David Shaddock

David Shaddock, Ph.D., MFT, has over forty years of experience as a psychotherapist. He is an internationally known expert on relationships who has taught and lectured in Israel, Italy, Mexico, and Chile. He is the author of two books on relationships and couples therapy. He is a clinical supervisor at the Wright Institute in Berkeley, and visiting faculty at the Tampa Institute for Psychoanalytic Studies. He is co-director of the Couples Therapy Interest Group of the International Association for Psychoanalytic Self Psychology. He is the author of three books of poetry and has won numerous awards. He maintains a private practice as a marriage and family therapist in Berkeley, California.