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The Impact of Shame on the Therapeutic Alliance and Intimate Relationships


  • We thank all of the participants who kindly agreed to take part in this study and the therapists who took time to help in the recruitment of participants. Special thanks go to Mary MacAteer, Mary Corry, and the Belfast HSC Trust Trauma Resource Centre for their contribution to this research.

Please address correspondence to: Kevin F. W. Dyer, School of Psychology, DClinPsych, David Keir Building, 18-30 Malone Road, Belfast, BT9 5NP, Northern Ireland. E-mail:



This study examined the role of shame coping styles and state shame in predicting the therapeutic alliance and intimate relationship functioning in individuals with mental health problems.


A sample of 50 treatment-receiving adults aged 21 to 67 years with a mix of common mental health difficulties was recruited from a clinical psychology service. Participants were given questionnaire measures of shame states, shame coping styles, intimate relationship functioning, and the therapeutic alliance.


Regression analyses indicated that the shame coping strategy of physical and psychological withdrawal was the primary risk factor for development of a less effective therapeutic alliance. Both withdrawal and attack self coping styles were significant predictors of impaired intimate relationship functioning.


These findings have implications for the theoretical role of shame in mental health presentations as well as the potential for internalizing shame coping styles (i.e., withdrawal, attack self) to act as a barrier to successful therapy and interpersonal relationships. The inclusion of shame-focused assessments and interventions in the initial stages of treatment with clients exhibiting these strategies could improve prognosis.