Psychiatry

Interpersonal and Biological Processes

ISSN: 0033-2747 (Print) 1943-281X (Online) Journal homepage: http://www.tandfonline.com/loi/upsy20

Feelings of Guilt in the Psychoanalyst

Harold F. Searles

To cite this article: Harold F. Searles (1966) Feelings of Guilt in the Psychoanalyst, Psychiatry,
29:4, 319-323, DOI: 10.1080/00332747.1966.11023475

To link to this article: http://dx.doi.org/10.1080/00332747.1966.11023475

Published online: 07 Nov 2016.

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 Feelings of Guilt in the Psychoanalystt
Harold F. Searles *

F IRST, before looking at the sources of what might be called the occupational guilt
inherent in doing analysis, we need to consider the possibility that our very choice
of analysis as a profession has been, to a significant degree, a guilt-based choice.
Thus, it may not be so much that our doing of analysis tends to promote guilt in us,
but rather that we originally entered this profession in an unconscious effort to
assuage our guilt, and that the practice of analysis fails to relieve our underlying
guilt. For example, we may have chosen this profession on the basis of unconscious
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guilt over having failed to cure our parents. Or we may be stubbornly clinging, still,
to forbidden, guilt-laden Oedipal aspirations, which find a tailor-made refuge, over
and over, in this profession, wherein "forbidden" erotic aspirations naturally, and
to a degree necessarily, tend to develop between patient and doctor.
Second, we can see that we do our their feeling so constricted by their iden-
daily work, as analysts, burdened or con- tity as physicians, a role that tends to
stricted by various traditions that are con- render them helpless in the face of the
ducive to guilt. The traditions of our patients' sadistic misuse of their con-
general culture do not value highly those scientious dedication.1
achievements that are intangible and of Our training, after medical school, in
a mental-emotional sort; we live instead the classical analytic tradition tends
in a culture that values a tangible job greatly, still further, to restrict the emo-
well done. But we do work that is neither
tions we can feel, without attendant guilt,
tangible nor, in the usual sense of the
term, completable. toward our patients. That is, much of the
classical literature and teaching gives us
Further, the medical tradition in which
we have been trained holds that, as phy- to believe that any reaction to the patient,
sicians, we should not have any notable beyond one of neutral attentiveness, is
feeling reactions to our patients except quite taboo. Further, while we urge
such feelings as active and compassionate or encourage or exhort the patient to say
dedication; as physicians, we are never whatever comes to his mind-while, that
to experience toward our patients such is, he "confesses all"-we are secretive
emotions as hatred, envy, rejection, and about our own thoughts and feelings-
so forth. In my work with psychiatric another built-in aspect of analysis, in
residents at a number of hospitals, I have
1 Harold F. Searles, "The 'Dedicated Physician' in
come to believe that nothing hampers Psychotherapy and Psychoanalysis," presented at
these young psychiatrists' efforts to work the Seventy-Fifth Anniversary Program, The Shep-
pard and Enoch Pratt Hospital, Towson, Md., June
with schizophrenic patients more than 18, 1966.
* A.B. Cornell Univ. 40: M.D. Harvard Med. School 43. Intern 44, Asst. Res. 44-45, New York Hosp.:
Capt. MC (Psychiatry) U.S. Army 45-47: Psychiatrist, VA Mental Hygiene Clinic, Washington, D.C. 47-49:
Hes., Chestnut Lodge SanitarIum, Rockville, Md. 49-1:>1: Res., VA Mental Hygiene Clinic, Washington, D.C.
51: Student 47-53, lIistr. 55-57, Teaching Analyst 57, Supervising and Training Analyst 58- , Washington
Psychoanalytic Inst.: Diplomate 53, Instr. 53-55, Washington School of Psychiatry; Staff Member, Chestnut
Lodge Sanitarium 52-64: Consultant in Psychiatry, NIMH, Bethesda, Md. 56-60 and 62- : Consultant in
Psychotherapy, The Sheppard and Enoch Pratt Hosp., Towson, Md. 63- : CUn. Prof. of Psychiatry,
Georgetown Univ. School of Med., Washington, D.C. 64- ; Lect. in Psychiatry, Nat!. Naval Medical Center,
Bethesda. Md. 64- ; Lect. in Psychiatry, New York State Psychiatric Inst., New York City, 64- . Diplomate:
Natl. Board Med. Examiners 45, Amer. Board Psychiatry 51. Member, Amer. Psychoanalytic Assn.,
Fellow, AUH:!!'. P"ychlaLl'lc Assn.
t This paper was presented as the author's contribution to a panel discussIon of Ulli< Bul/jed at a
meeting of The Washington Psychoanalytic Society, Washington, D.C., September 24, 1965.
[319]
 320
particular of classical analysis, which is
guilt-provoking.
Third, let us look upon the analyst's
guilt, now, in terms of its defensive func-
tions and its denial functions. Let us see
what unconscious feelings it serves to
maintain under repression in the analyst,
and what are the aspects of his patient
to which it tends to blind him.
The various traditional constrictions,
which I have mentioned, upon our own
emotional role tend to foster our projec-
tion, upon our patient, of our critical,
condemnatory, reproachful blaming-feel-
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ings, with the result that we tend chroni-
cally to feel guilty in the face of his pre-
sumed-in addition to his real-blaming.
We need clearly to realize that our invi-
tation to the patient to say whatever
comes to his mind need not carry with it
a guarantee of a neutral response on our
part. For far too long we have failed to
see that the analyst, not only for the sake
of his own mental hygiene but also in
order to work effectively as an analyst,
must be free to think and feel critically,
judgmentally, and, not at all seldom, con-
demningly.
Some seventeen years ago, while work-
ing in a chronically blame-ridden way with
one of my first patients, I found myself
having a difficult time trying to desist
from compulsive note-taking. I used to
notice that various of my patients in that
era would uneasily express wonderment
at my noting down everything they said,
no matter how trivial it seemed. With
this particular patient, I finally deliber-
ately put aside my notebook, determined
to stop this compulsive note-taking.
Within seconds, then, as he continued his
usual verbalized ruminating, I was im-
mediately struck with the thought, "What
shitf" In more recent years, from time to
time I have had the ironic thought that
instead of healing souls, I am half-consol-
ing heels. Likewise, whereas I used to
feel highly vulnerable to blame by the
parents of hospitalized patients with
whom I was working, I found this spectre
to vanish upon my experiencing an up-
surge of blaming feelings on my own part
toward the parents-blamins them for
HAROLD F. SEARLES
the fact of the patient's pathology. I do
not mean to say that this is a rational
and balanced view of the patient's illness.
But the recognition of my own previously
unconscious and projected feelings of
blame toward the parents greatly relieved
me from the dread I used to feel lest I
be blamed and condemned by them upon
their forthcoming visits.
Our guilt is likely to contain not only
unconscious condemnatory feelings, but
also sadism toward the patient. In our
guilty, overly-conscientious way of work-
ing, we tend to make him feel uneasy,
to feel himself a burden to us, to feel
that we do not enjoy seeing him and work-
ing with him.
Further, our guilt implies unconscious
contempt on our part, for it implies that
we view the patient as being so weak
and fragile that we fear we have irrepa-
rably damaged him by some past word or
act, or we fear that we would do so, if we
were to say to him what we are tempted
to say.
The guilt-ridden analyst tries to "keep
the patient in" treatment, consciously, in
face of the patient's outrageous demands
upon him, while unconsciously trying to
frighten the patient out of treatment
through an indulgent, cozening, pursu-
ing, devouring attitude (a reaction-forma-
tion against anger and rejectingness) ,
which arouses the patient's paranoid
fears. Here, increased freedom to feel
rejecting toward the patient is the spe-
cific remedy.
I want to note, further, that guilt in-
volves an unconscious clinging to the
past-the past as represented by the past
incident or situation about which we re-
main immersed in guilt-and is thus a
defense against feelings of loss on our
part.
I used to feel guilt at finding myself
powerless to help patients to experience
and express grief, and then gradually
came to realize that in situations in which
the patient is beginning to deal with grief,
nothing is required of me, except not to
interfere. This is an example of how, in
our guilt, we become overactive and in-
trusive, and interfere with the analytic-
 FEELINGS OF GUI1JT IN THE PSYC1l0ANALYST 321
growth process, Hence our guilt is apt to responses to the patient are felt by us as
cloak our unconscious wish to cling to crazy, for we fail to see their interper-
the patient. This is not a "bad" desire; sonal origin; these are felt instead as
only the fact that we repress it-in part being exclusively crazy and frightening
because of our medical tradition-is bad. upwellings from within us, threatening
As for those aspects of the patient to irreparably to damage or destroy the pa-
which our immersion in guilt tends to tient, who seems so insubstanii~and
blind us, I want here to mention, in par- fragile. Since we do not experience any
ticular, the patient's sadism. As I indi- clear and firm ego-boundaries between
cated about the psychiatric residents, we ourself and the patient, his acts are, in
tend repeatedly to lose sight of the ex- their guilt-producing capacity, our own
tent to which our patient is sadistically acts; we feel as guilty, about his sexual
thwarting our efforts to help him, and or aggressive or whatnot kinds of acting
sadistically enjoying watching us beat out, as though we ourself had committed
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our dedicated heads and hearts against and were committing those acts.
the cliff of his resistance. We fear to say the angry word to our
Time after time in supervision, I have patient, lest he be destroyed by it. So we
heard on recordings the sadistic quality suppress our anger, and it grows, and
of the schizophrenic patient's confusing we hate the patient for our unfreedom,
verbalizations, and the frustration of the and we feel guilty about our hate. Being
therapist as, quite unaware of the sadism, unfree, essentially, to relate to the patient,
he struggles on in his dedicated effort to we relate more and more to our own
untangle and decipher what the patient superego, our superego based upon the
is saying. Similarly, in my own work forbidding and punitive and constricting
with a schizophrenic woman years ago, figures from our own past. Also, we can-
she would repeatedly express the most not say the angry word for fear the pa-
intense physical anguish, and I, feeling tient's image of us-:-and worst of all, our
anguishedly helpless to relieve her symp- own image of ourself-as being omnipo-
toms, would keep trying desperately tently and unambivalently loving, be ir-
to explore them and to think of things retrievably lost.
to say. Then, as I became more aware Omnipotence-based guilt is really, then,
of the sadism in her reproachful ex- a relating to one's self-to, that is, warded-
preSSions of physical anguish, I left off off aspects of one's self-rather than a
trying to rescue her. Following this, genuine interpersonal relationship. It
she would hobble into the session, shuts out the patient; it represents a
wracked with pain, vent her fUry upon clinging to our own past; it underesti-
me for an hour, and walk out a physically mates the impact of the patient upon us.
rejuvenated and robust person. And to feel blamed by a blaming patient,
Fourth, I want to suggest that our most for what he feels to be early injustices
troublesome guilt reactions are a function on our part in the treatment, is a form
of our having regressed, in our relation- of disguised nostalgia, on our own part,
ship with the patient, under the impact for that earlier phase in the treatment.
of, and as a defense against, the help- In our guilt about not having made the
lessly ambivalent feelings that our work "right" response, we fail to see the depth
with him tends to inspire in us, to a de- of the patient's ambivalence-the impossi-
fensively symbiotic relationship with him, bility of there being any "right" response
in which our view of ourself and of the that will somehow satisfy, simultaneously,
world is an omnipotent view. In this state both sides of his conflictual needs. The
of subjective omnipotence, we are totally fact that the patient's desires are deeply
responsible for all that transpires in the ambivalent desires makes it inevitable
analysis, for there is no world outside us; that he will give us to feel, over and over
there is no real, flesh-and-blood other again, that we are failing him, that we
person. Hence all our erotic: find Imgry are unsatiRfar.tory, that weare not giving
 322
him what he wants and needs. Hence,
instead of remaining immersed in our
guilt, we should be pointing out to him
the presence of his conflict. Here, our
guilt reveals our own clinging to the om-
nipotent fantasy that life can be wholly
gratifying and conflict-free.
In our omnipotence-based guilt, we
try not to see that, while consciously
we struggle to help the patient to ma-
ture and become well, unconsciously
we have been struggling to make him
become increasingly regressed, and thus
to lend us a Godlike status, and vicari-
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ously to fulfill, through his acting-out, the
various warded-off aspects of our self. I
want to emphasize that we all do this,
in my opinion, in our work with all our
patients, in varying degrees.
Increasing freedom from neurotic guilt
requires us to become increasingly ready
to forgive our parents and others whom
we tend to blame for their falling short
of meeting our demands upon them. Such
persons notably include our patients;
occupational guilt probably has as one
of its most important roots the fact that
we are unconsciously focusing on our
patients the demands which our parents
failed to satiate, and the ungratifiability
of which we refuse to accept.
What else comprises the "way out of"
guilt? First, let us not feel guilty because
we feel guilty-that is only another facet
of omnipotence. In line with Mabel Blake
Cohen's concept about the inevitability of
our responding in terms of the patient's
transference, 2 we shall often feel guilt,
for the parents with their problems of un-
conscious omnipotence were such deeply
guilt-ridden persons. To give an example
of how guilty I used to feel because I felt
guilty, at one time I was working with a
very competitive, critical, compulsive
young man who came into the office one
morning and saw me trying to greet him
with my usual careful friendliness, while
hampered by a stiff neck. His immediate,
hawklike reaction was, "Ah!-feeling
guilty about something, eh?," to which I
could give only a wry, sickly grin.
• Mabel Blake Cohen, "Countertransference and
Anxiety," PSYCIIIATRY (1052) 15:231·243.
HAROLDF. SEARLES
In marked contrast, since I have been
doing more consultation work, I have
learned that a particular kind of guilt-
providing effect is one of the most reliable
criteria of schizophrenia. In general, in
most consultation and teaching interviews
done before a one-way mirror, for ex-
ample, I tend to feel callous, brutal, bully-
ing, and to feel that I have grievously
and inexcusably let down the so-eager and
needful patient. It is to the extent that
I can cope with such guilt feelings, and
look upon them in the light of what
they may be saying about the patient,
that I am able to do this work. When
I am left with such feelings in particular
intensity, feelings that I am unworthy to
be called a human being, I find this a
reliable diagnostic criterion of schizophre-
nia in the patient.
Repeatedly, in this discussion, I have
found myself starting to use the phrase
"unresolved omnipotence." It has dawned
on me, however, that omnipotence is
never "resolved," and that it is pernicious
to speak of such a fantasy as "unresolved
omnipotence." Rather, we need to become
more freely aware of our omnipotent
strivings, which are never "resolved"
throughout life and which remain, indeed,
our most priceless wellsprings of energy.
It has occurred to me that perhaps
a new set of moral standards needs to
evolve for anyone relationship, perhaps
even for anyone analytic session or any
one moment. At any rate, the essential
thing is relatedness to immediate, ever-
changing reality. To relinquish neurotic
guilt, which serves as a kind of restraint,
one must be able to find a better restraint:
reality. Neurotic guilt, as I have already
indicated, bespeaks poor relatedness with
immediate reality.
A random point, now: I have become
determined to give as good as I get, hour
by hour with my patients. In this way,
resentment does not build up in me, nor
guilt about such resentment.
The question of what are the realizable
goals of psychoanalysis is highly relevant
to this question of what is "the way out
of" guilt. One needs to come to reject,
for eXrtmple, t.he goal of enduring freedom
 FEELINGS OF GUILT IN THE PSYCHOANALYST
from envy, or guilt, or whatnot, on the
part of either patient or analyst. One
does not become free from feelings in the
course of maturation or in the course
of becoming well during psychoanalysis;
one becomes, instead, increasingly free to
experience feelings of all sorts.
How many of us can really accept, with-
out guilt, a patient with whom we are no
longer working? I cannot, and I feel
that my guilt contains not-too-readily-
conscious resentment at him for failing to
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323
fulfill all my expectations. But again, I
surmise that wholehearted acceptance of
the patient is another unrealizably omni-
potent goal. We could unambivalently
love and approve of and accept our patient
only if he were somehow able to personify
our own ego-ideal-and in that impossible
eventuality, we would of course feel mur-
derously envious of him, anyway.
35 WISCONSIN CIRCLE
CHEVY CHASE, MARYLAND 20015