This paper explores the thesis that individual, collective and iatrogenic shame might be the unacknowledged elephant in the room in couples therapy. A number of examples are cited of couples treatment where shame is either ignored or unintentionally encouraged. Reference is made to the author's earlier work (Shaddock, 1998, 2000) that cites shame, along with fears of abandonment and intrusion, as a powerful unconscious organizer of relationships. A discussion of the nonverbal origins of shame cites a consensus that it originates in the toddler phase, particularly in regards to derailments in the interpersonal regulation of states of heightened arousal. Attention is paid to the way couples' nonverbal communication can repeat or restimulate these mirroring failures. The paper then turns to an exploration of shame that is iatrogenic in the couples treatment process, in which telling or emphasizing the right way to relate or communicate ignores the shame inducing message that the couple is doing things the wrong way. Another source of shame in the treatment comes from the therapist adopting an expert or all-knowing attitude. The paper concludes with a case example of a couple whose conflict centered around how the wife refused to wear clothes that exposed her body. The key to the treatment was understanding the husband's shame as well as the wife's.