The necessity of combined therapy in the treatment of shame: a case report.

Abstract In some situations, combined psychotherapy may not be merely a choice, but a necessity for successful treatment. I present a case report of a hospitalized Vietnam veteran who had sexually abused one of his daughters. In individual therapy, the patient learned to speak about himself, his significant guilt, and his shame, in a trusting environment. After a year of outpatient individual work, I felt that the addition of group psychotherapy would help this withdrawn man to connect to a social milieu. Although anxious about self-disclosure and confidentiality, he joined a heterogeneous veterans' group, and came to reveal his secrets there. While he continued to use the individual sessions to broach painful issues, the group served to uncover material that had not emerged otherwise. The acceptance he experienced in the group expanded and cemented gains made in the dyad, which in turn made the ongoing group experience tolerable. His self-exposure and efforts at bonding and reparation catalyzed therapeutic movement for other members as well. The two modalities served to reinforce and make more powerful the effects of each. Therapeutic progress depended on the combined treatment-both were necessary, neither was sufficient.