Introduction: Shame seems to be one of our most unpleasant emotions. There are connections between shame and depression, acute stress syndrome and it is one of the main reason for committing suicide. Questions: What are psychotherapist´ views on the role of shame in the therapeutic process? Which are psychotherapist experiences when reducing shame has had a positive impact on humans well being? On the contrary what prevents us regulating shame and what are the difficulties in working with shame? Method: The study has a qualitative and hermeneutic approach and method of analysis is thematic. Five experienced psychotherapists participate. Result: Therapists have no experience of working with shame as a primary emotion. People are seeking therapy when shame is observed as anxiety or as a defence. Shame prevents us from our deep feelings as anger, sadness, love and interest etc. The non-verbal markers of shame do something with the whole personality and are close to our opinion about our self, that who I am. Discussion: The experience of shame reminds of the experience of anxiety and fear. Thereby we need to treat shame in the same way as we treat anxiety given Malan´s triangle of conflict. Otherwise the risk is high that the patient terminates treatment prematurely. The contrary to shame is that we are lovable and we need to reach that experience if we will be able to regulate shame in treatment. To achieve these, qualities as self-compassion, acceptance, non-judgemental is needed. Furthermore the therapist´ ability to create an alliance and that we start to speak about shame are important. / Inledning: Skammen räknas som en av våra mest obehagliga känslor. Skam har stor inverkan på människor och det finns samband mellan svåra skamkänslor och depression, utmattningssyndrom och självmordshandlingar. Frågeställningar: Vad är psykoterapeuters syn på skammens roll i den terapeutiska processen? Vilka är psykoterapeuters erfarenheter där skamlindring varit viktigt för patientens tillfrisknande?  Vilka är psykoterapeuters erfarenhet av skamlindring som hinder för patientens tillfrisknande? Vilka svårigheter finns för att arbeta med skam i terapirummet? Metod: Studien är kvalitativ med en hermeneutisk ansats och analysmetod är temaanlys. Fem erfarna legitimerade psykoterapeuter deltar. Resultat: Terapeuterna har ingen erfarenhet att arbeta med skam som grundaffekt. Människor söker terapi när skammen yttrar sig som en ångestkänsla eller försvar. Skammen hindrar oss att känna våra djupa känslor som vrede, sorg, kärlek, intresse etc. Det finns kännetecken på skam som gör något med hela personligheten och som ligger närma uppfattningen om sig själv, det jag är. Diskussion: Upplevelsen av skam påminner om ångest och rädsla. Vi behöver därför behandla skammen på samma sätt som vi arbetar med ångest utifrån Malans affekttriangel, annars är risken stor att vi tappar patienten. På det djupaste planet är skammens motpol att vara värd att älskas och vi behöver nå dit för att verkligen lindra skammen. Det krävs kvaliteter som självmedkänsla, acceptans, icke-dömande, terapeutens förmåga att skapa allians och att vi börjar prata om skam.

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The pupose of the study is to gain a deeper understandig of how sham and- guilt problems and coping strategies against shame and guilt are related to female abuse and addiction treatment. The study conducted five qualitative interviews with women who had previously been addicted to alcohol and/or drugs but had been drug-free for at least five years. Were conducted data were analyzed from a social constructionist perspectiv, as well with stamping theory and genus theory. The result showed that, according to their statements, the women had a greater tendency to feel shame and guilt for their addiction, compared to men. There was a discrepancy between perceived demands on "the good woman and mother" and women in addiction. The hidden abuse occurred often, being an outsider and marked as addictive woman and mother, created a destructive process of negative self-image, filled with shame and guilt. The coping strategies against shame and guilt were the perception of alcohol and drug dependency as a disease. The communities in women´s groups and in 12-steps programs, where women share their life experiences had contributed to their recovery.

My goal for this thesis is to investigate the concept of (mis)labeling female protagonists in contemporary British fiction as mentally ill—historically labeled as madness—when subjected to traumatic events. The female protagonists in two novels by Sophie Mackintosh, The Water Cure (2018) and Blue Ticket (2020), and Jenni Fagan’s 2012 novel The Panopticon, are raised in environments steeped in trauma and strict, hegemonic structures that actively work to control and mold their identities. In The Panopticon, this system is called “the experiment”; in The Water Cure, it is personified by the character King and those who follow him; and in Blue Ticket, it is the social structure as a whole reflected in the character of Doctor A. To simply label these novels’ woman protagonists as ill would be to ignore that their behavior is not mental illness but in fact rational behavior produced by the traumatic dystopian environments.