Category Archives: Guilt

Realistic guilt?

“Can I ask about realistic guilt? I have a patient who was married to an abusive woman, and she won rights to their children. His kids tell him of the abuse they suffer, but he is helpless to win custody of them as she’s good at lying to the system. Facing the anger towards her has eased his depression tremendously but he feels guilt for not being able to help his kids. I felt this was realistic and not self-punishment. Any ideas, please?

Another patient came in with CPD, and I spent the whole session regulating his anxiety with success. Second session he came in crying over his girlfriend who died. After facilitating his grief for 15 minutes, I learned he was 17 when it happened. He has been crying as if it was fresh for the past 30+ years. They were joyriding illegally in a motorcycle, they crashed, and she died. There was some suicidal ideation, so I asked him who the anger was toward if he didn’t turn it back into himself. After some defense he admitted it was towards a friend who goaded her into riding the cycle. When we get close to the anger, even
cognitively, he experiences memories of the war, followed by increased self-attack and guilt. I cognitively gave him awareness of his guilt, which he admitted felt different in a good way, but he just kept crying. Any help much appreciated!”
An important question with two great examples. Thanks for sharing this question!

Of course, there is such a thing as realistic guilt. Every one of us has done something to hurt a loved one, and, hopefully, we feel guilt about the wrong we did and reach out to repair the harm we did to that person and to our relationship. Healthy, realistic guilt mobilizes us to engage in the act of reparation. So let’s look at these two examples.

The first patient divorced his abusive wife and left his children with her. Inevitably, he feels guilt. After all, his freedom came at a price: he is not with them, and they suffer. I am not judging him, by the way. I am just pointing out reality: he was able to leave and the children could not. Understandably, his children are angry with him for leaving, and he feels guilt that he was able to get free but they could not, and they still suffer. Even though the legal system made the decision that the children stay with the ex-wife, he made the decision to leave. This is his painful burden to bear, one based on his love for his children. All he can do is feel his guilt and continue the act of loving his children, supporting them as much as he can, accepting their anger, listening to their pain, and bearing the complex feelings that arise when he has left a painful relationship his children could not leave. If he attacks or punishes himself for leaving, you will address that defense, so that he can bear the burden of guilt, which arises anytime a parent divorces, a decision which always, to some degree, involves pain and loss for the children. This is realistic guilt.

The second patient is a man who rode a motorcycle and had a crash that led to his girlfriend’s death. In effect, he killed her. Feeling enormous guilt, he wishes he could die to punish himself for her death, and, thus, expiate his guilt. Being angry with the man who encouraged the girlfriend to get on the motorcycle is a form of projection to avoid his own guilt. After all, the other fellow did not crash the motorcycle.

Tragically, this man suffers from cognitive/perceptual disruption. As a result, his ability to bear complex feelings and guilt is extremely low—note the use of projection to avoid the internal experience of guilt. Due to this low capacity to bear feelings internally, he has not been able to work through his guilt. He can grieve forever, but this, too, has served a defensive function. If he feels only grief over his loss, he can avoid guilt over his murder. I use this word because in his inner world he killed her. He drove the motorcycle. He crashed the motorcycle. She died because of his actions. Thus, he killed her.

If we therapists can face this kind of causality, responsibility, and guilt, we can help patients like him face the horrific guilt over being the cause of someone’s death. He knows in his heart that if he had not taken her on the motorcycle, she would be alive today. This is realistic guilt, based on a tragic mistake of engaging in illegal joyriding. Glossing it over will do him no good. But facing his guilt and his responsibility will help him heal, end his lifetime of self-punishment, and enable him to find ways of repairing the damage he did, even if those acts of reparation must to be for others, not the poor woman who met her death.

This takes emotional courage on the part of the therapist. We are not here to judge. But we are here to face the truth, even when it is an ugly truth, even when facing that truth will initially trigger a painful wave of feeling within the patient. Without judgment, without condemnation, but with compassion we can reach out to him and say, “Of course you feel guilty. You drove the motorcycle illegally. You crashed the motorcycle. She died because of your actions. That’s why you feel guilt. This is a sign of your humanity. Shall we face this guilt you’ve been carrying the past thirty years?”

These statements are not judgments, but statements of the facts. By stating them, we let the patient know that as two guilty humans, we can face facts together, bear the guilt together, and reclaim our humanity together and rejoin the human race after a long period, thirty years in his case, of personal exile.

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.