Presenter: |
Thomas Rosbrow, Ph.D. |
Chair: |
Sanford Shapiro, MD |
Self Psychology Page | 21th Conference
Program
Summary
In this paper I will present the ongoing treatment of a young man, Carl, who entered treatment in a paralyzed, obsessive state, characterized by severe self doubt about his work and his family relations. His sense of self was continuously undermined by the undercutting of his ideas by his parents’, particularly mother’s, total immunity to any form of criticism or disagreement by him. This led to a vulnerability in his sense of reality(Shane, Shane,and Gales, 1997) , in that he was eaten up by doubt regarding his values and personal choices. His fears and sensations of being wrong, weak, and unsuccessful made him exquisitely prone to feelings of shame, specifically embarrassment over perceived failure. His case illustrates prototypical themes about the circular, oscillating relationship between shame and guilt which I have observed in other patients with similar familial constellations.
He showed a particular form of guilt , here termed obligation guilt, which was a response to a sequence of feeling shamed, followed by parentally induced guilt. Weakened and momentarily shocked by shame caused by familial criticism and rejection, he was vulnerable to accepting parental attributions of wrongdoing or disloyalty. Obligation guilt is rooted in shame - in feeling failed and doubting one’s judgement and competence.This guilty and insecure position constitues a temporary self-state. The guilt-ridden state then leads to a more lasting painful core of obsessional doubt and rumination.
Obligation guilt can be usefully contrasted to the well-undertood concepts of survivor guilt and separation guilt (Modell,1984;Weiss and Sampson,1986;Friedman,1985), where a person is intensely concerned with anxiety over hurting and depriving others. With obligation guilt , the other is perceived as impervious, even if narcissistically upset. The person suffers guilt not over damaging the other, but about breaking ranks and being wrong. Perceiving oneself as wrong undermines a person’s sense of confidence and efficacy, and leads to a dreaded image of the self as indecisive and failed. As an alternative to this intolerable, shame ridden state, the person resorts at other times to character defenses of compulsive self-reliance(Bowlby,1980) or self-sufficiency(Modell,1984), where one imagines oneself to be free of other’s opinions and judgemnts, and possessing superior judgment to which others should submit- an identification with the omnipotent, critical parent. Carl would vacillate between two disparate personas: a self-assured, aloof, cocky man of the world who operated on his own with little need for mentors or colleagues, or, a frightened, intimidated, young man who did not trust his own instincts or ideas and was indecisive and overwhelmed.
In looking at the sequence of shame, guilt, and doubt, I am indebted to the pioneering work of Lewis(1971), who carefully delineated repetitive sequences of shame, rage, and guilt. Her emphasis on sequences has been followed in the work of Lansky (1992) and Scheff (1990). In the sequence she observed, shame is an intolerable affect which leads inexorably, reflexively,into rage, which functions to protect the self against further injury. The person often is horrifed at the extent of this rage, and then feels guilty for wanting to attack and hurt the person who caused the shame. This guilt depletes any sense of healthy self-assertiveness, the person feels weakened, and is vulnerable to being again shamed.The cycle is set to begin anew. In this formulation, guilt is secondary in importance, a byproduct of the destructive effects of shame-rage.
In his discussion of tragic and guilty man, Kohut(1982) also saw guilt as a less significant psychological force than shame. Droga and Kaufman(1994) tried to correct the self-psychologist’s valorizing of shame over guilt by referring to the guilt of tragic man, looking at underlying pattern of separation guilt and survivor guilt in some narcissistic personalitites.
The pattern observed with Carl, and other patients, has a different script,although the process begins with a painful experience of being shamed by someone, as in Lewis’ formulation. Both Lewis and Kohut contrast guilt with shame, emphasizing shame’s connoting diminished self-worth as opposed to guilt’s connoting destructive feelings and their opposition by the superego. In the sequence observed in this paper, obligation guilt gives form to the inchoate pain of shame, and is a response to the criticisms of caretakers. In this dynamic, shame and guilt are interconnected threads weaving together the particular pattern of a person’s sense of failure and wrongdoing, with either experience potentially in foreground or background.
The other major emphasis of this paper is on the mutative effect of taking an open, self-disclosing stance as a basic analytic attitude. To be warmly interested and responsive to a patient’s questions and interests is arguably a better starting point than to begin from a stance of neutrality and anonymity. If a major goal and ongoing process in treatment is the develpment of a new, safer, relationship with the therapist, then the therapist’s capacity to be vividly present as a real, useable person is essential. Of course, the degree to which the analyst may reveal values, opinions, or interests will vary according to the patient’s needs and wishes for mutuality,intimacy, privacy, or autonomy-and the patient’s needs for distance. But it may be better to begin from a position of friendly openness rather than cautious neutrality, and to adjust one’s bearings from that baseline. In working with Carl, I made the error of being too distant and non-disclosing in the first sessions- potentially leading to a flat unproductive treatment- but quickly reoriented myself to a different more openly related position, which helped the treatment open up and grow.