The Role of Shame and Humiliation in Relation to the Technical Difficulties in Providing Psychotherapy to a Six-Year Old Boy in Care

This thesis is a single-case post facto research study designed to better understand the intensive psychotherapy treatment of a six-year old boy in foster care, who I refer to as Freddy.
There were considerable technical difficulties I wanted to examine, including how in-terpreting and other attempts to bring attention to the internal world and psychic real-ity stirred up shame and humiliation for a boy with a history of maltreatment.
The literature review refers to work with looked-after children with childhood mal-treatment by child psychotherapists. Theories from adult psychoanalysis on narcis-sistic personality structures and object relatedness are also reviewed, and the link between shame, narcissism and the Ego Ideal is also explored. The growing body of knowledge that neuroscience offers our understanding of maltreatment is also re-viewed.
The research methodology used Grounded Theory to analyze psychotherapy ses-sions, from which initial codes and categories were developed into over-arching themes. The findings indicated that, despite difficulty in understanding the therapy as it progressed, important processes took place, and shifts in psychic development were evident, particularly in the ability to gain a different view of relating. Changes in Freddy’s ability to communicate relational anxiety were also observed.
The findings are discussed in terms the importance of the development of a mecha-nism for thinking about experience, and how early trauma and maltreatment can con-tribute to shame, humiliation and difficulties with psychic reality. Further discussion include the implications of maltreatment for child psychotherapy, clinical practice and future research.