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T O P I C    R E V I E W
shawnsmith Posted - 02/18/2013 : 07:46:45
Dealing with Guilt (only part of a longer article)

Howard Schubiner, MD

In some situations, there may be little or no anger, but a great deal of guilt may be present.
There has been a recent recognition that guilt is often a central feature of the post-traumatic
stress disorder (PTSD) experience. If there are issues in your life that have created guilt or
shame, you can use the ISTDP elements to help you heal.

Guilt is the feeling that is generated when we believe that we have done something wrong,
something that goes against what we were taught and our principles for how people should act.

Guilt is often a way of turning anger inward, as in the situation where one has really done
nothing wrong, yet continues to blame oneself. This is common among women who have been
physically or sexually abused. If you have been in a situation like this, it is imperative to look
critically at the situation and determine the truth: that you were really not at fault. You need to
stop believing that you did something wrong and work through the methods in this book to turn
the anger outward in a healing fashion and direct it towards the offender.

However, there are also many cases where we may believe that we really did do something
wrong, that we made a terrible mistake, and that people suffered because of this mistake. I have
seen this many times and if it is not addressed, it can lead to the development and persistence
of Mind Body Syndrome. It is important to understand where guilt comes from in order to deal
with it. Guilt comes from parents, families, religions, and cultures that teach us to be "good." Of
course, this is a desirable thing in general, but the desire to be good must be tempered with the
ability to act in our own best interests and to balance interests of others. No matter what we do,
there is a chance that we will disappoint someone by our actions. Learning that this is
unavoidable is necessary to live our lives.

Most people have rules by which they live and often
we are actually unaware of our own rules. In addition, our rules are often unrealistic or
unenforceable. Some examples are: I will never make a mistake; I will never disappoint anyone;
I will always do the right thing; or I will always be kind. To be human is to break each of these
rules sometimes and if we understand that, we can forgive ourselves for breaking such a rule.

When we are put in situations that are very difficult, such as abusing relationships, family illness,
economic hardship, or combat situations, it is very easy to make a mistake and violate a
principle that we hold. Almost everyone has made mistakes that have caused suffering in others.

The first step in healing is to understand that feeling guilt is a sign that you are actually a
good person who cares about what you do and the effect you have on others. The second step
is to realize that you are not the only person who has made mistakes and that it is very easy to make such mistakes when confronted with difficult situations. Since we are often our harshest
critic, it is also critical to learn to treat ourselves as we would treat a good friend. You would
console friends by telling them that they did the best they could and that making a mistake does
not make one a bad person, just a human person. Take some time to tell that to yourself, use
the writing exercises to do that as well, and consider the ISTDP-type exercises below.
As suggested above, we can often be hard on ourselves. However, it is also important to
be able to let go of other people’s expectations of us (sometimes known as guilt trips). It is
helpful to understand others but realize that we cannot always please everyone. Sometimes we
must say “no.” Learning to do this is part of growing up. In fact, there are times when it is
appropriate to be angry with those who lay guilt upon us! I advise expressing this anger verbally
or in writing as one would do in relation to someone who harmed you in some way, as described
below. Of course, you may need to directly address the issue with the persons involved
depending on the situation. One would do that kindly or assertively after expressing the anger in
a healthy (and private) manner.

Finally, you have to realize that you are an important person, that you need to act to take care
of yourself (who else will?), and that you deserve to be happy. While you cannot undo the past,
you can forgive yourself for your mistakes and make amends for them. You can move forward
with your life. You can act with goodness and kindness towards yourself and towards the people
in your life.

The first step in healing is to understand that feeling guilt is a sign that you are actually a
good person who cares about what you do and the effect you have on others. The second step
is to realize that you are not the only person who has made mistakes and that it is very easy to make such mistakes when confronted with difficult situations. Since we are often our harshest
critic, it is also critical to learn to treat ourselves as we would treat a good friend.
4   L A T E S T    R E P L I E S    (Newest First)
shawnsmith Posted - 02/18/2013 : 08:32:23
I would not be comfortable with videotaping.
Racer Posted - 02/18/2013 : 08:23:33
This has 8 parts on ISTDP.

https://www.youtube.com/watch?v=cKzmk2-xnzY
Racer Posted - 02/18/2013 : 08:20:45
Very nicely written, Shawn. The following link in the tmswiki says, ISTDP involves videotaping of both therapist and patient during sessions. Do you think the patients will be comfortable with videotaping?.

http://tmswiki.wetpaint.com/page/Intensive+Short+Term+Dynamic+Psychotherapy
shawnsmith Posted - 02/18/2013 : 07:59:39
A good affirmation here would be: "I am a good person who cares about the feelings of others."

Can you think of others?

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