Shame and Guilt: Impediments to Therapy
A one-day seminar with Jan McGregor Hepburn
London, 17 June 2017 (Saturday)
As therapists, we understand that the presence of persecutory guilt in our clients can be a considerable obstacle to internal change. While through the therapeutic process we can try to replace persecutory guilt by feelings that lead towards reparation; progress can be challenging and can often be thwarted if the client feels too worthless to be reprieved.
Our therapeutic challenges are further exacerbated when guilt coexists with shame, although it may not be explicitly manifest. To make any therapeutic progress now, we need to overcome the fact that shame is more than a primitive precursor to guilt; for shame to exist there has to be a person. If the self has been depersonalised, there is essentially no one to feel shame.
How do we work in such situations where shame and guilt co-exist or reinforce each other’s debilitating effects?
At this practical and unique seminar, which would be particularly relevant for psychotherapists, psychologists, counsellors and psychiatrists, Jan McGregor Hepburn draws on her longstanding experience in social work management and Psychoanalytic Psychotherapy to clearly illustrate two distinct processes which both carry the nomenclature of guilt:
- feelings of remorse and wishes to make reparation, which are in the service of development, and
- persecutory guilt, which is experienced as crippling and pervasive but which cannot be mediated by forgiveness or reparation, and is sterile and anti-development
She illustrates that in adult life or pathology these feelings are not in fact on a continuum, or indeed intimately connected with one another; they are different internal systems, and it is the persecutory sort which severely affects our clients’ ability to live their lives and which produces severe clinical challenges.
Linking these assertions with the co-existence of shame, Jan also explains how shame and remorse, when temporary and mitigated are part of normal development. Persistent shame can be pathological however, and the absence of shame can be manifest of a psychotic state of mind. She explains how shamelessness is a defensive projection against persecutory guilt and how this interplay can create therapeutic impasses.
Overall, the workshop explains how we can comprehend the main drivers for the acquisition and maintenance of persecutory guilt and persistent shame, enabling us, as therapists to recognise what cannot be repaired and what can.
About the speaker
Jan McGregor Hepburn has been the Registrar of the British Psychoanalytic Council (BPC) since 2005 and has a background in social work management and Psychoanalytic Psychotherapy. She is a trainer for the North of England Association for Training in Psychoanalytic Psychotherapy. She is the author of a number of journal articles and regularly speaks at national and international conferences. She is on the Reading Panel of the British Journal of Psychotherapy and is currently conducting doctoral research in Infant Observation at the University of Northumbria.
10:00AM: Session 1: Distinguishing between guilt and shame manifestations
In this first session we consider how feelings of guilt and shame are universal and examine how their distinction is more than a matter of semantics. We comprehend the clinical implications of this distinction and explore how guilt manifestations are actually not on a continuum.
11:15AM: Coffee Break
11:30AM: Session 2: The drivers of persecutory guilt and persistent shame
We build on our theoretical understanding from Session 1 and start comprehending the three main drivers for the acquisition and maintenance of persecutory guilt:
- holding and feeling the guilt on behalf of others
- obtaining perverse satisfaction from the secondary gains of such a position; and
- as a defence against feeling true remorse
we link these with the drivers of persistent shame and examine how these can co-exist.
1:00PM: Lunch Break (a light lunch is provided as part of the seminar)
2:00PM: Session 3: The illusion of maintaining a good object
We further build our understanding and delve deeper into a particular kind of identification that gives the illusion of maintaining a good object. We consider how the therapeutic interaction needs to build in the fact that the actual consequences of real objects need to be faced.
2:30PM: Session 4: Clinical Implications
In this session, we look at specific case vignettes that illustrate how our understanding of persecutory guilt and persistent shame can inform out therapeutic approach.
3:15PM: Coffee Break
3:30PM: Session 5: Plenary
Attendees will be invited to share their own clinical experiences and discuss any issues outstanding from the day’s sessions.
© nscience UK, 2016 / 17
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