Problems working with guilt

When patients experience their unconscious rage in therapy, they often do not experience their love and guilt. Why? Also, how do you work on anxiety when it goes too high during guilt work? What defenses do you look out for and how do you work with them? Why doesn’t guilt and love come through?

Thanks to Reza for these questions!

In all therapy relationships, mixed feelings rise toward the therapist, feelings based on the patient’s previous experience. Love arises because the patient wants to connect. Rage arises because previous connections hurt the patient.

Those mixed feelings trigger anxiety and defenses, which create the patient’s presenting problems. So the therapist helps the patient see and let go of those defenses to face the underlying feelings that have been driving a pattern of self-punishment through defenses.

To do this, the therapist explores feelings in a current, past, or therapy relationship. As the therapist helps the patient face and let go of defenses, often anger is the first feeling to break through. Once the anger breaks through to someone we love, however, guilt arises. Why? The rage is felt toward someone we love. That combination of love and rage toward the same person triggers guilt.

To avoid the anxiety triggered by the love and guilt, the patient may use defenses such as denial or devaluation. In my book, Co-Creating Change, (chapter on breakthrough to the unconscious) you will see how I suggest you work with sixteen different defenses that arise at that very moment, defenses that will prevent the breakthrough of the love, guilt, and grief.

However, sometimes the patient begins to experience the love, grief, and guilt, but has trouble bearing these powerful emotions and becomes overwhelmed with anxiety. If so, cognize about the anxiety briefly, make the link to the guilt, and build the patient’s capacity to bear this much guilt without becoming overwhelmed with anxiety.

Th: Notice how you are becoming dizzy? So we see that as soon as we touch on this guilt, you become anxious, and then your mind becomes dizzy. See that?

Pt: [sighs or tenses up] Yes.

Th: So what does you father’s face look like as you see what you did to him? [Explore images that will trigger higher levels of guilt so you help build the patient’s capacity and enable him to have a fuller unlocking of his unconscious.]

We call this a “pocket of fragility”. The patient is temporarily too anxious, but a brief summary is enough to regulate anxiety and we continue to go for as high a rise of feelings as the patient can manage.

Why don’t guilt and love come through after the rage? Defenses or anxiety block the way. Why?

Sometimes the therapist goes for a premature breakthrough before having explored feelings long enough to mobilize the unconscious enough to have a breakthrough. I have seen therapists go for a breakthrough after asking for feelings only three times…instead of after twenty or thirty minutes!

Sometimes the patient has shifted from resisting feelings to resisting emotional closeness. Thus, the patient is distancing from the therapist with a transference resistance. If the therapist does not see this, no breakthrough will be possible. See my earlier blogs on signs of the emerging transference resistance.

Sometimes the patient’s resistance is in the system of projection or repression where further restructuring is necessary before a breakthrough to complex feelings would be possible, or even advisable! Premature breakthroughs with these groups of patients can lead to regression or depression.

Sometimes the therapist does not recognize the defenses which are preventing a rise of unconscious feelings. If we address the wrong defenses, the unseen defenses will block the way. That’s why having an expert look over your videos is essential. He or she can help you see what you need to do to help the patient further.

If love and guilt do not arise after a breakthrough to rage, look for the defenses that are getting in the way. If you help the patient feel only rage, without her love and guilt, we only help her get better at denying her humanity through denial, detaching, projecting, or devaluation. Experience of rage by itself is almost never helpful. Our task is to help the patient embrace the fullness of her humanity: her rage, her love, her guilt, her grief, and her wish to connect.








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