Category Archives: Guilt

Should the patient feel guilt over rage toward the therapist?

“Reading Patricia Coughlin’s book, I see that when the patient experiences murderous rage toward the therapist, she encourages the guilt and longing feelings with the therapist and then after that encourages links to past figures. In the immersion with Abbass, he was clear that we do not encourage guilt with the therapist after the murderous rage toward the therapist, but encourages the patient to look at the dead therapist’s eyes to see figures from the past. What are your thoughts on this? I have read a lot of your work but can’t see this point being made anywhere.” Good question!

You can let the unconscious do what it does. Sometimes the patient feels guilt while looking at your face and a genetic figure comes up that way. We ask, “What feelings are coming up as you look into those dead eyes?” This primes the way for the patient to see someone else. Another way to think about this is, “Why would the patient feel guilt about rage toward us?” The patient hasn’t actually done anything except share a fantasy. So the guilt that rises is coming from somewhere else. You are just the vehicle that allows these mixed feelings from the past to rise.

Like Allan, I do not invite the patient to feel lots of guilt vis a vis me. I’ll just ask what feelings come up as he looks at “the dead eyes” or “dead body”. With more feelings mobilized, I’ll ask, “Who comes to mind?” Then we’re on our way. It’s important to realize that the goal of the portrayal is the unlocking of the complex feelings toward people in the past, not toward you. Your imaginary body is just the gateway to the unconscious. Don’t stay at the gateway. Go on in to the unconscious.


Guilt: Conscious and Unconscious

Recently a student wondered if guilt was a feeling or a defense.  What a great question!

Conscious Guilt as a Feeling

If someone slaps you in the face, let’s hope he feels guilty afterward!  Why?  Because his guilt, an adaptive feeling, may mobilize him to reach out to you, apologize, and try to repair the damage he caused to the relationship.  Sometimes, however, when we experience our guilt, it makes us anxious.  So we use defenses: denial (“I didn’t mean anything by it.”), rationalization (“The reason I did it was that you were being a jerk.”), or minimization (“I think you are being too sensitive about it.”)  If we use those defenses, we fail to repair the damage we caused, and our relationships fail.  Genuine guilt is a healthy feeling.  It mobilizes us to repair the damage we have caused others (Melanie Klein).  And defenses against facing conscious guilt prevent us from healing our relationships.

Self-Punishment as a Defense against Experiencing Conscious Guilt

Sometimes, we run into another defense, which can fool us.

Pt: “I just feel so guilty about what I did to Sam.”

Th:  “Did you apologize to him?”

Pt:  “No.”

Here, the patient narcissistically withdraws into self-punishment rather than reach out to repair the damage.  Her so-called ‘guilty feelings’ are a form of self-punishment as a substitute for reparation.  ‘I will punish myself rather than reach out to the person I hurt.’ (See Donald Carveth

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