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Theoretical and Clinical Aspects

Helm Stierlin, MD, PHD

Arch Gen Psychiatry. 1974;30(3):381-389.

Abstract
Shame and guilt denote painful and complex experiences. These interweave with, yet also differ from, each other. The three psychoanalytic constructs of ego-ideal, conscience, and self-observation—all forming part of the superego—illuminate their differing dynamics. Often shame and guilt recur sequentially in shame-guilt or guiltshame cycles.

This report describes shame-guilt cycles, also called shame-guilt binds, in families. It distinguishes between marital (vertical) and intergenerational (horizontal) shame-guilt cycles or binds. In each case, complex homeostatic processes come into play. Pseudomutual and pseudohostile families, as described by Wynne et al, reveal typical variations of these processes. To an extent, such homeostatic features of shame and guilt serve positive functions, but easily become restrictive, and then interfere with each member's individuation and separation. When this happens, they must become a focus for interpretative psychotherapeutic intervention.

The family therapist must work toward the voluntary acceptance, rather than the forced admission, of shame and guilt. Also, he must be able to deal with family myths and must see the above binds in a multigenerational perspective.

Author Affiliations
Bethesda, Md

From the Family Studies Section, Adult Psychiatry Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Md.

Footnotes
Accepted for publication Oct 29, 1973.

Reprint requests to the Family Studies Section, Adult Psychiatry Branch, National Institutes of Health, Bethesda, MD 20014 (Dr. Stierlin).

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