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Christian Schulz-Quach M.D., MRCPSYCH, FHEA Shame is a central, yet under-explored, affect in psychoanalytic theory and practice. This paper critically examines the phenomenology of shame through classical Freudian, Modern Psychoanalysis, existential-phenomenological, and queer theoretical frameworks. Drawing on psychoanalytic and neuroscientific evidence, I highlight the early developmental and relational roots of shame, as well as its enduring presence in the context of trauma and minority stress. Special emphasis is placed on the distinctive qualities of queer shame and its relational, social, and systemic dimensions. Clinically, shame emerges not only as a powerful and overwhelming affect but also as a force that can profoundly disrupt the therapeutic process for both patient and analyst. Its intensity often evokes defensive patterns, impasses, and ruptures in the analytic relationship, challenging the safety, trust, and mutual engagement within the therapeutic space. The emotional contagion of shame can lead to avoidance, withdrawal, or enactments, requiring both participants to navigate moments of acute vulnerability and exposure. Attending to these dynamics, the paper explores the ethical conditions necessary for a meaningful and transformative engagement with shame, focusing on values such as non-maleficence, dignity, acceptance of identity, safety, fairness, and accountability within the analytic encounter. By integrating these perspectives, I propose a model for working with shame in psychoanalytic psychotherapy that is sensitive to ethical, existential, and identity-based considerations, while also attentive to the ways in which shame’s disruptive force must be both tolerated and thoughtfully contained. Theoretical reflections are grounded in a detailed clinical vignette, illustrating the transformative possibilities—and challenges—of analytic work with shame. The paper concludes with recommendations for psychoanalytic ethics that honor the vulnerability and complexity of shame, particularly in diverse and marginalized populations.

With Mehr-Afarin Kohan, MD, FRCPC Social action has been observed to be a remedy against invisibility and despair. It helps individuals to join in, take on roles, become members of something larger than them, which is an antidote to losing hope and a way of bridging different self-states. (Shapiro & Carr, 2017) In coining their concept of “Relational Citizenship”, Hassinger & Pivnick (2022) discuss how participation and collaboration in groups built on “tolerating differences with empathy, mutuality and accountability” (pg. 124), where members are beneficiaries as well as contributors to a common cause, provide an opportunity for members to regain hope and vitality by experiencing themselves as part of something larger. It is in the act of joining in, of becoming a citizen of a group that the individual finds an opportunity to reclaim/reinvent/rediscover self-states while maintaining their integrity. (Shapiro & Carr, 2017)

With Brent Willock Ph.D., C.Psych. Through careful analysis of rich clinical material, this article explores the proposition that at least some, perhaps many, transgender identities may be formed to manage (defend against) prior developmental relational challenges and trauma. Adverse experience during the stage of differentiation out of the dual unity that Winnicott, Mahler, and others emphasized may prompt some boys to retreat to the security provided by earlier, undifferentiated, primary identification with their mothers. The diagnostic and treatment value of considering this possibility and perspective is underscored. Two children’s profound wish to understand their difficult developmental trajectories is examined, along with their astonishing ability to utilize art to tackle their questions about their developmental identity histories (who they are, where they came from, and where they are going). Without thorough understanding of these early developmental processes and defenses, it may be difficult or impossible to provide optimal assessment and treatment for these individuals.

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