Individual Differences Research

Journal Menu

Individual Differences Research > Volume 24, Issue 2 (2026) > e24009

Shame and Guilt: Psychodynamic Foundations and Clinical Manifestations in Outpatient Practice

Werner Merkle

Abstract

This psychodynamic paper examines the metapsychological differentiation and early childhood genesis of shame and guilt. While a mature sense of guilt represents a conflict between the Ego and the Superego, shame affects the global self-image, often arising from a painful discrepancy between the real self and the perfectionistic demands of the Ego-Ideal. This theoretical paper utilizes a clinical case vignette of a 53-year-old patient to illustrate how these dense intrapsychic dynamics can manifest in outpatient practice through psychosomatic somatization and delinquent behavior. Modified treatment techniques for the outpatient setting are discussed, highlighting a holding, non-judgmental therapeutic relationship. Furthermore, it is demonstrated how these phenomena can be understood complementarily from the secondary conceptual lens of Alfred Adler's individual psychology as goal-directed arrangements.

RESEARCH ARTICLE

Published 

August 11, 2026

Keywords 

Shame;

Guilt;

Metapsychology; Psychosomatics;

Outpatient Psychodynamic Psychotherapy;

Individual Psychology