Shame in Psychotherapy: Richard Erskine on a Relational, Developmental Understanding

In this interview, I asked Richard Erskine about the concept of shame—and why the way we define shame fundamentally shapes how we practice psychotherapy.

Richard reflects on how, until the 1990s, shame was largely absent from clinical literature and often confused with guilt. He shares how his clinical work, personal analysis, and professional collaborations gradually revealed shame as a central organizing experience in many forms of psychological suffering.

In our conversation, we explore:
• Why shame is fundamentally relational, rooted in early disruptions such as humiliation, criticism, defining, or being ignored
• How shame is not one emotion, but a five-part constellation, including:
• hurt (not being accepted or cherished),
• fear of rejection,
• disavowed anger,
• compliance,
• and the core belief that “something is wrong with me”
• Why each component of shame requires a different therapeutic response, rather than a single technique
• How shame can appear across diagnostic categories (e.g. borderline, narcissistic, depressive presentations), often with different “faces” but a shared underlying process
• Why psychotherapy itself can unintentionally become shaming, especially when problems are overly pathologized
• The importance of presence, unconditional positive regard, and I–Thou relating in creating safety for working with shame
• How defenses such as self-righteousness or arrogance function as protection against unbearable shame—and why these require patience and long-term relational work

Richard emphasizes that working with shame is not about quick interventions, but about repeatedly returning—moment by moment—to respect, attunement, and truth-telling within the therapeutic relationship.

This conversation is especially relevant for therapists and trainees interested in Integrative Psychotherapy, relational psychoanalysis, trauma-informed care, and developmental perspectives on personality and defense.

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🔗 Learn more about Richard Erskine and Integrative Psychotherapy
• Richard Erskine’s website:
👉 https://www.richarderskine.net/
• International Integrative Psychotherapy Association:
👉 https://integrativetherapy.com/en/ind...

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