ABSTRACT Although shame is a central affect running through all phases of psychosexual and social development, it is usually masked by guilt and therefore it is not readily recognised, explored, and understood within the therapeutic situation. Moreover, there is a tendency to treat all shame manifestations as if they operate at the same level. The author proposes the need to distinguish between two qualitatively discrete manifestations of shame states which, albeit intertwined, operate at different levels and require different understanding and technique: a primary, unconscious kind based on psychobiological survival and triggered by a condition of psychic and physical danger, and a secondary, social shame, mainly conscious, based heavily on vision and evoked in social situations. The natural, primary form of shame becomes pathological after catastrophic chronic exposure of the primitive ego to unthinkable anxieties. Such premature rupture of primary skin containment may result in omnipotence-based pathological organisations impeding or precluding acceptance of guilt and need for reparation. Pathological primary shame predisposes the individual to states of pathological secondary shame. When initial traumatic conditions are re-activated and re-experienced in therapy, they may trigger re-enactments and, possibly, a negative therapeutic reaction. Recognising variations and mixed states of primary and secondary shame states, especially when shame is compounded with guilt, can provide guidance in the assessment of the fragility of the ego, and therefore inform our technique and the therapeutic process. This theoretical position is discussed with the help of clinical material from a twice-weekly psychotherapy of a 16-year-old boy imbued with shame compounded with guilt, related to transgenerational objectification and dehumanising experiences.

中文翻译：

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“我是 Ceadas 的孩子吗？”：探索青春期男孩心理治疗中羞耻感的本质和体验

摘要 虽然羞耻感是贯穿性心理和社会发展所有阶段的核心影响，但它通常被内疚所掩盖，因此在治疗情况下不容易被识别、探索和理解。此外，人们倾向于将所有羞耻表现视为在同一层次上运作。作者提出需要区分羞耻状态的两种定性离散表现，尽管它们相互交织，但在不同层次上运作，需要不同的理解和技术：一种基于心理生物学生存并由心理和身体危险条件触发的初级无意识类型，以及次要的社交羞耻感，主要是有意识的，主要基于视觉并在社交场合引起。自然的，在原始自我灾难性地长期暴露于难以想象的焦虑之后，羞耻的主要形式变成了病态。这种初级皮肤收容的过早破裂可能导致基于全能的病理组织阻碍或排除接受内疚和需要赔偿。病理性原发性羞耻感使个体倾向于病理性继发性羞耻感状态。当最初的创伤状况在治疗中被重新激活和重新体验时，它们可能会触发重演，并可能引发负面的治疗反应。识别主要和次要羞耻状态的变化和混合状态，尤其是当羞耻与内疚混合时，可以为评估自我的脆弱性提供指导，从而为我们的技术和治疗过程提供信息。