Guilt or self-punishment?

“A client separated from his wife, but left his kids with her, and they suffered when she neglected them, often leaving them alone at home. He began to lead the life of a hermit, throwing himself into work, and detaching himself from everyone but his kids whom he met on weekends. Now that he is getting old, and his business is in crisis, he feels guilty for immersing himself in work as a defense against his feelings of anger, loss, grief and guilt. We have done a lot of work and he is far better today. But he ruminates about his son who is not married, nor settled professionally, and he blames himself for leaving his son with his mother at age five. Or he worries about his unmarried daughter—what if she falls ill or gets into an accident and is alone with nobody to care for her? When he ruminates about other close family members, he often calls them to ensure they are safe.
What are the interventions to make to help him face his guilt over leaving his children? And how do we address his obsessive rumination over the safety of others? Is the rumination a projection of anger or is it rooted in his guilt too?” Thank you for this important question!
While divorce may be the right thing to do, it always causes pain for others. In this case, there is the additional pain this man suffered because his ex-wife neglected their children. Thus, he inevitably feels guilt about his choice and its consequences for his children. However, as we look more closely, the picture is more complicated.
He ruminates (defense) about a son who is not married or settled professionally. This raises the possibility that he may be angry with his son for not living up to his expectations, and that rumination may be a form of self-punishment. The only way to test that hypothesis is to explore feelings toward the son and see if those feelings trigger anxiety and defense. Then you will find out whether the rumination is a form of self-punishment, not guilt.
He ruminates (defense) about his daughter, worrying about her falling ill with nobody to take care of her. Again, we would want to explore feelings toward his daughter who had moved far away. Is his rumination a defense against his anger toward his daughter for leaving him and moving far away? Or is he projecting upon her his own worries about being ill, alone, without someone to take care of him? Only exploring feelings toward the daughter will allow us to test these hypotheses.
He ruminates about family members, and then he calls them to put his fantasies to rest. Since the ruminations make him suffer, they are defenses. Thus, we might explore feelings toward each family member he ruminates about to find out what feelings are underneath his ruminations.
If you can help him face his feelings and feel them, he won’t have to ruminate as a form of self-punishment for having those feelings.
In other words, there is a lot of exploring of feelings necessary here in order to get clear about the triangle of conflict in each example. However, here is a big hint. When we talk about guilt in ISTDP, we are usually referring to UNCONSCIOUS guilt, buried under defenses.
The conscious guilt that patients report almost always has a defensive function. For instance, a patient might report feeling conscious guilt about leaving his son as a child, but this may ward off unconscious guilt due to his current rage with his son for failing to meet his expectations.
Just as conscious guilt can ward off unconscious guilt, the conscious crime may distract us from the real one. A person might say she feels guilty about snubbing a colleague at a work party, but exploration may show she actually feels much more guilt over having stolen the credit for a report written by her colleague who now will not get a promotion.
Remember that whatever guilt patients report is what the defenses allow to come to the surface. Conscious guilt distracts us from other deeper feelings. For instance, doesn’t it sound better to say, “I’m worried about my daughter’s health,” than to say, “I’m furious with my daughter for leaving me here all alone when she should have stayed nearby to take care of me!”
If you can help him face his rage and complex mixed feelings toward his children, he will no longer have to punish himself through his rumination, and then he can accept the loss of a child he always has loved and always will, even if from afar.

3 thoughts on “Guilt or self-punishment?

  1. George Williams

    Hi, this is George Williams.
    Thanks for your interesting and challenging question. It would be nice to have a few more details so I would not have to make any assumptions. I have a lot of questions as I read the background.
    The time chronology is not clear. Your client has been under your care for how long? Did his wife receive any therapy? Did he continue to see them consistently every weekend? Did he feel he devoted his time to them on the weekends? What was it like with them? How did they adjust in school, with each other, etc.?
    I ask these questions to determine whether his guilt is based on a reality of his destructiveness and neglect or he has rage and is blaming himself and punishing himself for their life situation.

    I have examined a few sentences of your information one at a time and made comments about them. First is your comment in quotes and then my analysis or questions.

    “A client separated from his wife, but left his kids with her, and they suffered when she neglected them, often leaving them alone at home.”

    When did he separate from his wife? His son was 5 years old and his daughter a similar age? How did she neglect them? To what extent? Was it to a level that Children and family services could have been called in at the time? How did he feel about the neglect? He saw them on the weekend. Have you reviewed with him the details of the experiences he had learned about his children’s neglect? Leaving them alone at home for how long? How often? What was she doing? Did she have some serious problems? Alcohol, drugs, other men?
    This is all crucial information to know as it helps you put the reality and his feelings in perspective. There is a good possibility that what his children went through is what he went through as a child.
    Two points: 1. Reviewing the patient’s experiences with them on the weekends and his objective perception of how they were doing and the evidence of neglect and how this affected the children according to his memory and perception.
    2. Helping him to face his feelings about what they went through and how he failed them or was there for them during that time. Possibly he actually spent more time with them after he left his wife. Since this is still bothering him, I think you need to go back and gather the information and look at his feelings. It appears he still has a lot of feelings about the separation and the impact on his life. What is his character like? Does he focus and project onto others the pain that he has inside or related to his childhood when his father or mother was not there for him?
    ASSUMPTIONS: Please remember I am making this up as I do not have the information:
    1. He separated from his wife when he was 35 yo. He had two children, a boy 5 and a girl three years old. (All this information is vital for examining the reality of the emotional impact on his children of what happened and if there is any link later in therapy to his childhood.)
    2. His children remained with their mother the whole time, but he would pick them up on the weekends and would have them all Saturday from Saturday morning 9am to Sunday night at 8 pm. They slept overnight at his modest apartment. He had no girlfriends during this time. (What was he like with the children on the weekends? What are his memories of them and him together? What did he do with them? What was his mood? Did they talk about their mother? In a positive light? A negative light? Did they have a stepfather or how many partners did his wife have? What were his feelings like for his wife? Did he get over her? How did the divorce happen? Why did they separate? Who wanted the separation? How was his relationship with his children before separation from his wife? Were the children part of the problem? What was their conflict about between the wife and husband?
    3. You met up with him 2 years ago, and he is now 62 years old. His son is 32 years old, and his daughter is 30 years old. Both the son and daughter live alone in cities at a distance from him, so it is not easy for him to visit them or check on them in person. (Their ages are again important and to know the details of their lives and how they perceive their own lives? Are they happy with their lives? Do they worry about him since he lives on his own? Do they have boyfriends/girlfriends, many friends, no friends?
    ( All these questions are fundamental during your investigation of the reality of the situation and whether his perceptions are distorted or reality. The task is to put all his feelings in the right perspective, not torture himself for the remainder of his years.)
    4. You saw him for the last two years and have been helping him. It is not clear what you have addressed and how you have helped him, in what areas? And how he sees a difference. Clearly, there are still many issues to address and resolve.

    “ He began to lead the life of a hermit, throwing himself into work, and detaching himself from everyone but his kids whom he met on weekends.”

    So this would suggest he was punishing himself by isolation and keeping busy with work to distract himself. I have already indicated the questions about his weekends with the children. How did he living like a hermit affect the children?

    “Now that he is getting old, and his business is in crisis, he feels guilty for immersing himself in work as a defense against his feelings of anger, loss, grief, and guilt.”

    How old is he? I assumed 62 years old, and he separated when he was 35? How does his business crisis tie into this dynamic? He realizes that work is not so important or that all that devotion and work ended poorly so how valuable was it really? Now, he understands that his relationship with his children is more valuable than work? Did the business crisis trigger him to see you or this is a new event with worsening of his symptoms? So it seems reasonable that you are correct that he immersed himself in work to avoid all his feelings.

    “We have done a lot of work, and he is far better today.”

    So there are a lot of questions about this. To examine your concern we need to know how all your work ties into his worsening symptoms. I am making assumptions as you have not provided the information details.
    ASSUMPTIONS: You have been working with him for two years.
    What has he changed in this time? How does he perceive the work? Has his relationship with his children changed?
    Was this obsessional worry there the whole time or has it started up recently?

    “But he ruminates about his son who is not married, nor settled professionally, and he blames himself for leaving his son with his mother at age five. Or he worries about his unmarried daughter—what if she falls ill or gets into an accident and is alone with nobody to care for her? When he ruminates about other close family members, he often calls them to ensure they are safe.”

    So it is essential to know the onset of these symptoms as this will help understand the culprit and how far back the feelings go and what has triggered these recent symptoms if they are indeed recent.
    These specific worries and concerns definitely must have an unconscious connection to his past and his core pathology. You need to explore all these worries one by one and to examine the feelings that come up as you go along the path of his fear.
    Questions to ask patient in your exploration of his fears about his children: “What are you afraid of happening? And then what would happen then Mr. Smith in your imagination? You are concerned about your son’s profession. What is he doing now? What are you afraid of happening to him professionally? And if that happens what is your fear?
    Mr. Smith: I am afraid he will become homeless.
    Th: and then?
    Mr. Smith: He will freeze in the cold, and he will be found dead one day on a park bench.
    This line of questioning could very lead to the source of his anxiety, which is his feelings about some past figures or himself or something that is very significant in his unconscious. Once he experiences the feelings about the past issue that is linked to his worries, the symptoms will disappear, and he will not ruminate about it anymore.
    Just like the healthy man that Dr. Davanloo has presented countless times, who got involved with his sister in law sexually on a couple of occasions and he transferred his guilt about it onto obsessing about information and numbers everywhere including work and at home. After one session his symptoms were gone. Dr. Davanloo has described how the symptoms have a direct link to some aspect of the patient’s core pathology. So I think it might apply in this man’s case for that part of his ruminating that is causing suffering to him.

    What are the interventions to make to help him face his guilt over leaving his children? And how do we address his obsessive rumination over the safety of others? Is the rumination a projection of anger or is it rooted in his guilt too?”

    So in answering your question:
    1. Explore his fears in the present and follow the anxiety to find its source. Do this with each child individually. Do this before any confrontation between reality and his perception of the children. You want first to follow his fear and projections on the children to get to his feelings that link to the past. If you prematurely point out the reality of the children, then you are closing the path to looking at his unconscious projections of figures of the past and possibly a projection of himself as a child onto his children.
    2. Much more exploration of the past before separation, after separation and now.
    There needs to be a much more in-depth exploration of his relationship with his children, before the separation, on the weekends all the way up to the present. Help him to face any feelings along the way.
    3. Focus on his need to punish himself and motivation to examine his core issues where there may be an engine of rage and guilt about his childhood, NOT about the marriage and children. His children/ ex-wife may be the trigger, and the feelings may start with the children or ex-wife but end up with his childhood caregivers and significant figures of the past.
    4. Start with the obsessional fear of the children or the relationship with the ex-wife. However, there is anxiety about the children. You have the task of just following the anxiety, and it will lead you to the source of all his feelings. Pursue inquiry along the path of the anxiety regarding his fears regarding his children, you will reach many feelings and then it will link to his childhood. Also, more in-depth exploration of his relationship with his children and his wife can lead there also. He has kept himself a hermit, you said. Why? Possibly he is remaining faithful to his ex-wife unconsciously that has a link to a figure from the past, aunt, grandmother, mother, father, older sister, younger sibling. Do not speculate. Just follow the trail of the anxiety bread crumbs, and you will reach the pot of feelings linking to the past.

    Hope this gives a different perspective and some ideas to help you approach his present problems.
    George Williams

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  2. George Williams

    Hi, George Williams again.

    I do not like reading Dr. Frederickson’s comments until after I have submitted my own. I find it interesting to look at the different perspectives and not to be influenced by what I read that he wrote first.
    Now that I have read his comments I do have some comments.
    I fully support Dr. Frederickson’s comments. He approached it a little differently than me, but we come to the same conclusions. The patient has unresolved feelings about his children. We both agree that his present ruminations are just a defense against underlying feelings about is children, and most likely there will be rage as clearly his ruminations are a way he is punishing himself in the present. I am saying that usually the rage and guilt link back to the genetic figures, meaning this man’s parents and that most likely his childhood experience has some connection to the children. I would suggest that an exploration of his relationship with his children in the three segments of his life could bring up all his mixed feelings about his children. This could easily include his present anger about them abandoning him now (if that is his perception and neglecting him) as again it will most likely link to his parents or other significant figures leaving and neglecting him, and he has just repeated the pattern with his own children.
    I find it fascinating that both Dr. Frederickson and I are fundamentally saying the same thing that the feelings concerning his children will bring up all the mixed feelings about them, possibly including his feelings about his parents or other significant figures from the past. We also both agree that his present “conscious guilt and ruminations” are just a defense against much more disturbing and conflicting feelings about some figures, possibly including his children, ex-wife and his parents and/or siblings.
    George Williams

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  3. Miles

    “Or he worries about his unmarried daughter—what if she falls ill or gets into an accident and is alone with nobody to care for her?”
    In my experience, this sort of “worry” is classic sexism. A woman needs a man to take care of her. It goes hand in hand with the expectation that any single woman is looking for a husband. End of story.
    But there is also the aspect that he is getting to retirement, and having financial problems. It may be that he is looking to his children to take care of him now, when he didn’t take care of them when they needed it. I think Jon is hinting at this a little bit.

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