I think that Caroline was extremely lucky to find a therapist who would allow her to feel so accepted and patiently understood. This period of her work focused on Caroline's overcoming her identification and compliance with her parent's negative views of her. She was working on reducing her crippling sense of shame about herself. I think that her feelings of shame have a complex function for her. It seems that our patients are often plagued by shame - I think there are several possibilities for this and I am sure that Don, Jim and others can offer some other ideas and theories to explain this prevalent phenomena. In fact one of my patients recently brought in one of Don's books and told me how helpful it was to him in gaining an understanding of his experience!
In CM we see patients as feeling very much like their parents -identified with and as if they are as bad as they experienced their parents. In fact we feel one of our patient's biggest obstacles to change is how uncomfortable they feel feeling different from and better off than their parents. The experience of feeling shame unites one with his or her parents- you are the same as the person who in Caroline's case was so hurtful, thoughtless, and cruel. She couldn't bear to be like them or to be different from them. If you are like them then you are capable of or guilty of doing the same things to others that were so to you. If you allow yourself to differ from, and do better than your parents, you risk the danger of "shoving the truth" into your parents face. This creates the possibility of making your parents see how bad they were and thus risk hurting them or damaging them simply by being a different, separate person.
Weiss believes that one's emphasis on one's own shame prevents this process from continuing on it's natural course until the consequences to your family and self do not feel so dire. In the supportive atmosphere that Jamie created over this period, Caroline was able to test out her fears that Jamie and her parents couldn't handle her "health" and growth and separation. I think this was an important period of consolidation, questioning and development for Caroline. She was healthy enough to allow herself to try out having some successful experiences. Her tendency to feel responsible for and worried about her parents prevented her from feeling comfortable seeing them clearly. To see their problems drew her right back into the pit she was trying to flee. I have made this same error many time myself thinking that a patient would be helped to see their parent more clearly only to find it back fires as they end up with increased worry and quilt about separating. One must first feel free to be separate and be different before one can allow one self to see one's parents clearly and have true empathy for them. Otherwise the empathy is too damaging to one's need to feel independent and free to grow and have a life of one's own. So in that sense shame in CM theory provides the glue that keeps one close to, attached to, and as stuck as one's parents until the therapeutic support and insight allows one to feel free to move away from the scripts (compliance's and identifications) one has with one's family.
There is a research project currently in process (O'Conner et all) that examines the relationship between guilt and shame. There is a post above (guilt and shame research10-03) on this research that might be of interest. In part it refers to how "Weiss has specifically suggested that patients who first present with symptoms that appear to be most related to shame, are often struggling unconsciously with survivor guilt, and that the feeling of shamefulness may have the effect of reducing or concealing this guilt. He describes shame in some cases as an indicator of powerful and unconscious survivor guilt. "