After lying, feel guilty about why
Psychotherapy and guilty responsibility: ways out of guilt
Although becoming guilty is part of everyday life, dealing with guilt is little discussed in psychotherapy. The phenomenon is complex and multifaceted. The most important thing for processing is whether the guilty person can forgive himself.
Strokes of fate can be endured - they come from outside and are coincidental. But suffering through your own guilt - that is the sting of life, ”is how Oscar Wilde describes the agony of feelings of guilt, as if he had written them down very thoroughly for himself. But although becoming guilty is part of everyday life, dealing with guilt is astonishingly little discussed in psychotherapy. A central topic in forensic psychotherapy, hardly anything of the actual problems or hurdles in dealing with debt reaches the specialist public. Do most psychotherapists tend to delegate the issue to the churches? Or is being guilty potentially so agonizing, sometimes even devastating, that it arouses comprehensive defenses - even among psychotherapists? Becoming guilty as the central experience of human existence is as inevitable as it is unbearable. And yet: guilt does not disappear by itself. Guilt can pile up, guilt must be accepted and paid off at the same time. Becoming guilty is an existential question and a task rolled into one.
The psychologist who has presented the most comprehensive standard work on the subject of guilt is not a psychologist, but a writer: With his novel “Schuld und Atonement”, Dostoevsky has a broad compendium of being guilty between willfulness and projective entanglement, between lack of ego strength and demonic Malice presented.
With the numerous characters in the book, Dostoevsky declines virtually all the variations in blaming oneself. The main character Raskolnikov suffers a range of emotions between triumph and agony in the face of his willful double murder. His inner process between denial of guilt, admission of guilt, repentance and the desire for reparation is depicted vividly and nuanced. Anyone interested in guilt psychology and the psychodynamics of intentional as well as involuntary perpetration will find ample information here.
But how do psychotherapists actually work with the phenomenon of guilt? Before answering this question, it is important to differentiate precisely. Because neurotic feelings of guilt are an almost everyday phenomenon in many treatments. They occur in many disorders, for example in the context of the basic depressive conflict. And the neurotic background of the feeling of guilt can usually be alleviated or healed: As the ego learns a healthier self-esteem regulation, the severity of the super-ego weakens and the ability to delimit and constructive aggression grow, they will gradually disappear. But real guilt remains, poses different questions and requires different inner development steps.
An expert in the psychotherapeutic treatment of guilt is Dipl.-Psych. Annette Brink, head of the department for psychotraumatology and the psychotraumatological outpatient clinic at the Berufsgenossenschaftlichen Unfallkrankenhaus Berlin. Around 100,000 patients, the majority of whom are victims of traffic and work accidents, are treated in this hospital every year - and of course some of them are not only victims, but also cause accidents with fatal consequences for others. In a conversation with the psychologist it quickly becomes clear that the phenomenon of guilt is complex and one would do well not to generalize. "No person and no event are the same, each treatment is always a bit of new territory," she says.
Debt life different
It is therefore important to orientate oneself in this heterogeneous picture and to structure the phenomenology of guilt processing. Three levels of observation can be worked out: On the one hand, we can ask about differences in the quality of guilt. On the other hand, it is important to shed light on the different feelings of guilt. And finally, there are also individual differences in the processing of guilt.
First, on qualities of guilt. Because the specific context of a culpable event is of course of central importance for its processing. How many people were affected? How clear is the connection between the action and the fatal or life-threatening consequences? Above all, however, it is about the bond with the victim concerned. Annette Brink names essential factors that intensify the guilt life in most people. Above all, this is the closeness to the victim affected - for example, the emotional closeness to relatives, friends or lovers. It is not surprising that causing a loved one to die triggers greater consternation than when it comes to a stranger. But everyday practical proximity is also crucial. Being responsible for the death of a work colleague or a neighbor often leads to severe shock. In addition, there is a “quasi-general principle of causation of guilt that shakes almost everyone particularly hard,” says the psychotraumatologist, “namely when a child is affected. This is almost always experienced as the culmination of horror ”.
So there are external factors that can trigger different degrees of severity of feeling guilty. Ultimately, however, the subjective assessment of guilt is central. Because the inner “guilt landscapes” can vary astonishingly. What seems to overwhelm one person in terms of guilt is somehow workable for the other, perhaps not even worth mentioning for a third. How can these big differences be explained? The music therapist Isabelle Frohne-Hagemann speaks of the culpability. From a legal point of view, people only become guilty when they are of legal age. At the same time, psychotherapy should examine the capacity for emotional guilt. Because the ability to experience guilt is essentially dependent on the ego structure, i.e. on the coherence and stability of the ego functions. If this is given, a person will with a high probability endure feelings of guilt and gradually come to terms with them. Acute crisis situations limit the functionality of the ego and thus also the ability to process guilt. In the psychotraumatology department of the trauma hospital under Annette Brink, for example, careful attention is paid to when the person who caused the accident receives news of the injured or dead.
The ego functions and thus also the guilty capacity of a person can also be chronically impaired and then go hand in hand with a high level of narcissistic insecurity - in the sense of: “Am I OK the way I am?”. If a person is insecure in his sense of self, guilt can overwhelm. Because in order to tolerate guilt and to be able to endure it, a minimum of narcissistic homeostasis is required - otherwise the mental balance would be threatened too strongly. In these cases, a comprehensive protective shield seems to be effective, which comprehensively denies and keeps questions of guilt at bay. It starts with the aspect of premeditation. Is guilt per se undone if the act was not done on purpose? Children argue like that. And of course, with this consideration, questions of guilt can be quickly and safely closed. Then the ego remains protected from the challenges of conscience. But can intentionality be answered so clearly with yes and no? Where does individual responsibility for one's own actions begin? Is the father who beats up his child innocent because he was beaten as a child and cannot help but pass on the trauma suffered in perpetrator-victim reversal? We often encounter these questions in our psychotherapies. And here, too, it becomes clear that the more intact the ego functions of the person responsible, the better the prerequisites for dealing with guilt.
Even if in principle there is a guilty capacity, a wide range of debt processing can be observed. It is obvious that the handling of guilt is determined by qualities of the personality structure. In the case of dissocial personality disorder, i.e. when a person lacks empathy and conscience functions, the basic requirements for experiencing guilt are missing. Conversely, people with pronounced depressive-compulsive components tend to get entangled in brooding self-reproach. The confrontation with one's own strict conscience can then sometimes take on masochistic and self-tormenting features.
Recently, the American feature film “Manchester by the Sea” has fanned out very impressively how a man threatens to break under the burden of his guilt. In a drunk state, he carelessly caused his house to burn down, and his three children died in the inferno of flames. As viewers, we feel how unbearable and suffocating life is with this guilt and how much the father wants to punish himself with joyless living conditions. Only the careful closeness to his nephew and the attempt to talk to his wife, who left him after the accident, can shed light on the extensive spiritual devastation. This also shows what the psychotraumatologist Brink describes as the most dramatic escalation in the processing of guilt: the amalgamation of feelings of guilt with grief for the deceased. A sometimes indissoluble conglomerate of barely bearable feelings. Mourning is blocked by the sense of guilt, the processing of guilt by grief.
Conversely, the film also makes transparent what essentially supports the processing of guilt. Because just as being guilty occurs within a social structure, processing of guilt is not conceivable in isolation from the social context. From this point of view, being guilty affects not only the guilty party, but also those around them. Annette Brink, for example, describes the case of two work colleagues - the carelessness of one has seriously injured the other on the construction site. For the rehabilitation of the guilt, the reaction of the work environment and the boss was very decisive. By conveying to the guilty party that this would inevitably happen and that it could in principle happen to anyone, the guilt life was reduced and in the meantime they could both work well together again as colleagues.
In psychotherapeutic practice, it is about a careful history of the event, its processing and available resources. How is the capacity for guilt and the guilt experience determined by the structural characteristics of the ego and the personality structure of the patient? Especially where the ego functions and self-esteem are limited, it will be a matter of strengthening them first - which always means taking stock of the existing and activatable resources. Specifically, this also means being interested in the social environment of the person affected: Who can possibly help in dealing with questions of guilt and also make love and consolation tangible?
Precisely because guilt is such an existentially human issue, the focus also shifts to its spiritual anchoring: Can an inner dialogue arise with a God who forgives and accepts? Or can it have a Buddhist orientation in which self-compassion is of great importance? Dealing with guilt is far more open and easier when belief or spiritual practice tears gaps in the often stubborn walls of self-reproach, and we do well in psychotherapy to ask about spiritual orientations, values or ideas.
Finally, it is important to pay attention to whether there is an overlap with traumatic experience - then trauma-specific methods are particularly necessary to resolve trauma, grief and guilt. Brink and her team like to work with the EMDR method, especially in their work with those responsible for road accidents: "It is so well suited because you can proceed in small steps and gradually work through the individual facets of guilty life," says Brink.
Of course, the therapist always comes to grips with his countertransference. It would be difficult to work with a guilty patient whose culpable involvement is a deterrent and appalling. So these questions also come to the fore for successful therapeutic treatment: How do I relate to the real guilt of the patient? How much to blame do I put on him? Can I accompany him through his questions without bias? Only then will we presumably become sufficiently good “storage places” for the guilt-related feelings and doubts of the patients - based on the containment concept of the British psychoanalyst Wilfried Bion.
In a successful dispute, the main focus will be whether the guilty person can forgive himself. Forgiveness of the injured party is also helpful for dealing with the guilt of the perpetrator, but what is essential is forgiveness in front of oneself. Then questions about possibilities of reparation can come into focus, which are as individual as the guilt dynamics themselves. Most of these processes take time. If we accompany them psychotherapeutically, it will always be about starting with the specific abilities and possibilities and making available resources usable. At best, guilt can gradually transform itself: from a sting, as Oscar Wilde describes it, to a healing wound, the traces of which are presumably permanent and which become part of being human. Dr. phil. Vera Kattermann
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