The role of shame in psychopathology and implications for therapeutic practice
Using a cross-sectional design, a self-report measure of proneness to shame and guilt was administered to 86 patients with moderate to severe depression, with the prediction that there would be a positive correlation of shame with severity of depression. Contrary to other, non-clinical studies, it was found that guilt but not shame was associated with levels of depression. Shameproneness demonstrated a unique association with a stable attributional style for negative outcomes, general negative self-evaluation, submissive behaviour, negative automatic thoughts, social anxiety and internalised anger. Shame-proneness and guilt-proneness were both associated with dichotomous thinking or 'splitting'. A range of childhood adversity factors was also investigated derived from ratings on the Childhood Experience of Care & Abuse interview (the CECA) including childhood sexual and physical abuse. Contrary to prediction, no relationship was found between shame- or guilt-proneness and a reported history of childhood sexual or physical abuse. From the other childhood adversity factors, only childhood maternal indifference demonstrated a positive association with adult shameproneness. Empirical findings are discussed including limitations of the measure used in this study to assess shame- and guilt-proneness. A content analysis of the CECA interview data showed that maternal indifference, as characterised by maternal emotional unavailability, was the most significant component. These results give empirical support to the psychoanalytic concept of the role of mirroring in childhood, and a clinical case-study is presented to illustrate the role of childhood maternal indifference and adult shame-proneness, presenting within a narcissistic personality organisation. Finally, overall findings are summarised and implications for working with the shame-prone patient in therapeutic practice are discussed.