Shame in the Psychotherapy for Psychosis

Jeremy Ridenour, PsyD, ABPP, co-authored (with Jay A. Hamm, Bethany L. Leonhardt, Benjamin Buck, Brett Thatcher & John T. Lysaker) "Shame in the Psychotherapy for Psychosis" in the Journal of Contemporary Psychotherapy.

(from the publisher)

"Shame is an emotion that is known to trigger and exacerbate psychotic symptoms and can lead to negative treatment outcomes. While shame has received some attention in the recovery literature, little has been written about how therapists can be sensitive to the overt and covert presence of shame and the ways it might result in states of withdrawal or paranoia and create barriers to forming a relationship with a person experiencing shame and psychosis. In this paper, metacognitive reflection and insight therapy, a therapy that promotes meaning 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 to shame and its concealment, addressing external shame, reckoning with internal shame, and exploring shame within the therapeutic relationship. These guiding principles can help therapists gain more awareness of how shame may be operating and affecting their work with patients with psychosis."

DOI: 10.1007/s10879-026-09716-x

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