Morrison A P
J Am Psychoanal Assoc. 1984;32(3):479-505. doi: 10.1177/000306518403200303.
Shame is a central human affect, reflecting feelings of defect, inferiority, and failure of the self. It is, therefore, a proper focus for psychoanalytic treatment. Beginning with Freud's seminal attention to narcissism and the ego ideal, the possibility for studying shame and its relation to the ego ideal (i.e. the loving function of the superego) was inherent in psychoanalytic theory, but Freud's pursuit of intrapsychic conflict and the punitive superego postponed further elaboration of shame. Interest in the relation of the ego ideal to the superego (Hartmann, 1950; Reich, 1954), and in the ideal self (Sandler et al., 1963; Schafer, 1960, 1967) opened the way to further study of shame. Kohut's contributions, with their focus on narcissism and self-pathology, have given a language and perspective on self-deficits allowing elaboration of shame's place in psychoanalytic treatment. In this paper, I have focused on the treatment of shame in two patients. I suggest that shame lies at the very center of the narcissistic patient's pathology, with primary internal shaming (directed at the self's failures and inadequacies) permeating all aspects of the treatment. For the neurotic patient, shame is more circumscribed, reflecting partial failures of the self; it tends to be reactive, relating to passive withdrawal from internal conflict and castration fears, and is intermixed with oedipal manifestations. I have described clinical sequences that demonstrate my approach to working with shame in each of these patients. In both cases, the task is to recognize, acknowledge, accept, and investigate the patient's shame. Only after such empathic investigation can underlying conflictual and genetic derivatives be productively pursued. This sequence is often intuitively followed in analysis, but in this paper I have attempted to articulate more systematically shame's role in psychoanalytic treatment.
羞耻是一种核心的人类情感，反映了自我的缺陷感、自卑感和失败感。因此，它是精神分析治疗的一个恰当焦点。从弗洛伊德对自恋和自我理想的开创性关注开始，研究羞耻及其与自我理想（即超我的爱的功能）的关系的可能性就内在地存在于精神分析理论中，但弗洛伊德对心理内部冲突和惩罚性超我的追求推迟了对羞耻的进一步阐述。对自我理想与超我关系的兴趣（哈特曼，1950；赖希，1954），以及对理想自我的兴趣（桑德勒等人，1963；沙弗，1960，1967）为羞耻的进一步研究开辟了道路。科胡特的贡献，以其对自恋和自我病理学的关注，为自我缺陷提供了一种语言和视角，使得能够详细阐述羞耻在精神分析治疗中的地位。在本文中，我重点关注了两位患者的羞耻治疗。我认为羞耻处于自恋患者病理学的核心位置，原发性内部羞耻（针对自我的失败和不足）贯穿治疗的各个方面。对于神经症患者，羞耻更为局限，反映了自我的部分失败；它往往是反应性的，与因内部冲突和阉割恐惧而产生的被动退缩有关，并与俄狄浦斯情结的表现交织在一起。我描述了临床过程，展示了我在治疗这两位患者时处理羞耻的方法。在这两个案例中，任务都是识别、承认、接受并探究患者的羞耻。只有经过这种共情探究，才能有效地追寻潜在的冲突性和遗传性衍生物。这个过程在分析中常常是凭直觉遵循的，但在本文中，我试图更系统地阐述羞耻在精神分析治疗中的作用。
