ABSTRACT
This chapter focuses on the guilt-ridden patient and the frustration he/she often evokes in the therapist. The frustration partly results from a mistaken therapist assumption, namely, that the patient and therapist are involved in a conversation. In reality, the severely guilt-ridden patient is consumed with an internal “uncivil” war. One part insists that he/she is a good person, that he/she has done nothing wrong. The other part could not disagree more and reviles the patient in the most severe terms. The patient is pre-occupied by the incessant reverberations of the internal conflict. Three things can cause the therapist to be blind to the patient’s self-absorption: the therapist’s mistaken assumption of his/her importance; a lack of appreciation of the patient’s pre-occupying internal process; and the simple habit of assuming that when two people exchange words that they are having a conversation. Reassurance is not a helpful response. A compassionate comment or question directed at the patient’s internal dilemma is likely to be more useful.
