Shame is an innate affect built into human nature by evolution, with the purpose of protecting the self and social relationships. Adaptive shame is healthy and crucial for self-identity and navigating relationships with others. However, core shame or toxic shame can result from repeated inappropriate shaming during childhood. In this dissertation the author seeks to uncover the neurophysiological and psychological development of shame in order to determine how a therapist might recognise deep-rooted shame in their clients. The neurophysiological development is looked at through Stephen Porges’ polyvagal theory. The psychological construct presented is informed by object relations theory and attachment theory. Defence mechanisms which are commonly used to control, avoid or deny shame are explored in order to identify patterns which might point the therapist towards the presence of core shame. The therapeutic implications of shame are explored along with a number of approaches which have been considered useful when working with shame.