title: Understanding what is hidden. Shame in sexual abuse.
abstract: Competence in treating the victims of sexual abuse and exploitation requires an understanding of shame, the complex and multilayered emotion triggered when we have been exposed or when our self-esteem has been reduced. The experience of shame is initially physiologic, involving a cortical shock momentarily halting higher cognitive function, but followed immediately by a host of associations to previous experiences of shame. Acutely, the affect itself impels hiding, while defenses against it include anger, humor, silence, and a wide range of behaviors. In our culture, all sexuality involves an interplay between exposure and privacy, between control and release. The sexual abuse of adults and the sexual exploitation of children must produce shame, study of the interaction between abuser and abused suggests that shame conflict figures prominently in the genesis of such activity. To the extent that psychotherapy itself involves exposure, it must trigger shame; thus, it is likely that the therapist unskilled in the recognition of shame in all its disguises will overlook or misunderstand many of the issues that should form the core of our treatment of those whose sexual selves have been abused or exploited.
authors.affiliation: Institute of Pennsylvania Hospital, Philadelphia.
authors.forename: D L
authors.initials: DL
authors.lastname: Nathanson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002650:Child Abuse, Sexual / Q000523:psychology*; D003674:Defense Mechanisms; D005260:Female; D006167:Guilt; D006801:Humans; D007179:Incest; D011613:Psychotherapy / Q000379:methods*; D011902:Rape; D012752:Shame