The patient shifts some narcissistic investment into the idealization of the analyst. My clinical work however, leads me to understand shame as primarily an affective experience from which defenses develop. Even when shame in fact serves as defense, the affective experiential nature of shame needs to be understood and acknowledged. Shame is a genuine human affliction that requires treatment, which may be frequently overlooked in part because it inevitably reverberates with shame experiences in the therapist. In other words, because most therapist have not experienced their own full shame analysis, they collude with the patient to keep these feelings unrecognized and unexamined.
Shame presents in various ways, often very subtle.
It is helpful to learn the language of shame. It is also beneficial to become familiar with defenses of shame including addiction, denial, withdrawal, rage, perfectionism, exhibitionism, and arrogance. It is almost always present in patients with impulse control issues. Shame has different significance in the treatment of different types of pathology. For the neurotic, it will tend to relate to failure in action, often reflecting defensive passivity against oedipal aggression, competition, and desire.