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<p>Shame is an emotion that is known to trigger and exacerbate psychoticsymptoms and can lead to negative treatment outcomes. While shame has received someattention in the recovery literature, little has been written about how therapists can be sensitiveto the overt and covert presence of shame and the ways it might result in states of withdrawal orparanoia and create barriers to forming a relationship with a person experiencing shame andpsychosis. In this paper, metacognitive reflection and insight therapy, a therapy that promotesmeaning making and the ability to reflect upon the contexts that give rise to shame, is described.Four key guiding principles elements are outlined to combat shame, including attending toshame and its concealment, addressing external shame, reckoning with internal shame, andexploring shame within the therapeutic relationship. These guiding principles can helptherapists gain more awareness of how shame may be operating and affecting their work withpatients with psychosis.</p>

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Shame in the Psychotherapy for Psychosis

  • 期刊论文

  • 发表日期：

    2026年1月27日

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  • Jeremy M. Ridenour,
  • Jay A. Hamm,
  • Bethany L. Leonhardt,
  • Benjamin Buck,
  • Brett Thatcher,
  • John T. Lysaker

摘要

Shame is an emotion that is known to trigger and exacerbate psychoticsymptoms and can lead to negative treatment outcomes. While shame has received someattention in the recovery literature, little has been written about how therapists can be sensitiveto the overt and covert presence of shame and the ways it might result in states of withdrawal orparanoia and create barriers to forming a relationship with a person experiencing shame andpsychosis. In this paper, metacognitive reflection and insight therapy, a therapy that promotesmeaning making and the ability to reflect upon the contexts that give rise to shame, is described.Four key guiding principles elements are outlined to combat shame, including attending toshame and its concealment, addressing external shame, reckoning with internal shame, andexploring shame within the therapeutic relationship. These guiding principles can helptherapists gain more awareness of how shame may be operating and affecting their work withpatients with psychosis.