The Central Role of Guilt in Symptom Removal
This content delves into the intricate interplay between guilt, rage, and suffering in psychotherapy, emphasizing the significance of guilt for symptom alleviation and personal growth. Insights are shared on guilt stemming from conflicting emotions towards loved ones, leading to various forms of psychological distress and the necessity of patient anxiety tolerance. The narrative further explores how acknowledging and processing guilt can facilitate the resolution of internal conflicts, paving the way for emotional healing and enhanced self-awareness.
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Presentation Transcript
The Central Role of Guilt in Symptom Removal and Capacity Building 2021, Cathexis Psychotherapy Conference
UPCOMING COURSES: ALLAN ABBASS APRIL 29-MAY 2: SWISS SOCIETY FOR ISTDP: 3 DAY IMMERSION COURSE ON SEVERE FRAGILE CHARACTER STRUCTURE. HTTP://REACHINGTHROUGHRESISTANCE.COM/WP- CONTENT/UPLOADS/2021/04/FLYERABBASSMAI2021ENG-REV.PDF JUNE 2-4, 2021: MODERATE AND HIGH RESISTANCE: REACHING THROUGH RESISTANCE SERIES WITH ISTDP SAN DIEGO https://www.eventbrite.com/e/moderate-and-high-resistance-in-istdp-a-3-day-immersion-w-allan-abbass- tickets-130895621327 JULY 14, 2021: ISTDP FOR FUNCTIONAL NEUROLOGICAL DISORDERS. ONLINE 3 HOUR WORKSHOP HTTPS://WWW.EVENTBRITE.COM/E/FUNCTIONAL-NEUROLOGICAL-DISORDERS-ISTDP-APPROACH- TO-DIAGNOSIS-TREATMENT-TICKETS-141454077955 AUGUST 26-28, 2021: 7TH DANISH ISTDP IMMERSION: FINDING AND WORKING WITH THE FRONT HTTPS://WWW.EVENTBRITE.COM/E/DETECTING-AND-WORKING-WITH-THE-FRONT-IN-ISTDP- TICKETS-134417693941 SEPTEMBER 2-4, 2021: 10TH SWEDISH IMMERSION IN ISTDP: ISTDP FOR PERSONALITY DISORDERS: ASSESSMENT AND TREATMENT. HTTPS://WWW.EVENTBRITE.COM/E/10TH-SWEDEN-IMMERSION-IN-ISTDP-PERSONALITY-DISORDERS- TICKETS-133870856335 SEPT 29-OCTOBER 1: 18TH HALIFAX IMMERSION IN ISTDP: ASSESSING AND TREATING FUNCTIONAL SOMATIC DISORDERS HTTPS://WWW.EVENTBRITE.COM/E/18TH-HALIFAX-ISTDP-IMMERSION-FUNCTIONAL-SOMATIC- DISORDERS-TICKETS-132329046741
Main Points 1. Guilt about rage stems from love and rage toward the same person 2. This guilt produces multiple types of misery and suffering 3. This guilt can only be experienced when the patient can tolerate a high degree of love and rage at the same time: Anxiety tolerance 4. Experiencing guilt about rage undoes the need to suffer 5. Being aware of guilt about rage builds anxiety tolerance moving the patient from repression, projection, splitting or dissociation to isolation of affect and Striated Muscle anxiety!
BOND With Parents BOND With Others
BOND With Parents PAIN FEAR Rage, Guilt about the Rage Self-destruct Symptoms Somatization
Transference (Therapist) Current person Past person
Unconscious defense Unconscious anxiety Unconscious impulses and feelings
SPECTRUM OF PSYCHONEUROTIC DISORDERS SPECTRUM OF FRAGILE CHARACTER STRUCTURE Moderate Resistant Low Highly Resistant Severe/ Borderline Mild Moderate Resistant
SPECTRUM OF FRAGILE CHARACTER STRUCTURE SPECTRUM OF PSYCHONEUROTIC DISORDERS Low Resistant Resistant Moderate Highly Resistant Severe/ Borderline Mild Moderate Grief Violent rage, guilt Murderous rage, guilt, grief Primitive murderous rage, guilt, grief Primitive torturous rage, guilt grief
Guilt Burden: Low Resistance SPECTRUM OF PSYCHONEUROTIC DISORDERS Low Resistant Resistant Moderate Highly Resistant Severe/ Borderline Mild Moderate Grief No Rage No Guilt
Guilt Burden: High Resistance SPECTRUM OF PSYCHONEUROTIC DISORDERS Low Resistant Resistant Moderate Highly Resistant Severe/ Borderline Mild Moderate Tense, detach, avoid and self attack. MILD GUILT Some have repression to smooth muscle, depression and motor conversion MASSIVE GUILT
Guilt Burden: Fragile Character Structure SPECTRUM OF FRAGILE CHARACTER STRUCTURE Moderate Resistant Low Highly Resistant Severe/ Borderline Mild Moderate Resistant Cognitively disrupt, dissociate, motor conversion, self-attack, repression, projection, splitting Massive Guilt Massive Craving of Bond
Moderate Resistance Resistance Mid rise: Resistance crystallizing in transference Clarify + Challenge Complex Transference feelings Unconscious therapeutic alliance Unlocked Low rise: Inquiry and Pressure P P R R Th
Unlocking Partial Unlocking: some somatic pathway of love, rage, guilt and grief are experienced to small degree: UTA link to past person. Major Unlocking: Most of the rage is felt: UTA Image of current person or therapist changes to past person with a significant passage of guilt. The more guilt is experienced, the better the outcome
Somatic pathways of feelings Love: rising warmth, urge to smile and embrace Rage: rising heat/energy up chest to head then down arms: tension, anxiety and symptoms drop or stop Guilt about rage: Hard solid waves, pain in upper chest. Feel as if, for example, have just murdered loved one. Grief: tears, painful feeling in chest. Waves not as hard and distinct as guilt. Not as loud or painful.
HIGHLY RESISTANT PATIENTS Severe early attachment trauma Severe pain, primitive rage and guilt Resistance of Punitive Superego: Need to self defeat and self sabotage Major problems with closeness: kill relationships Can be many symptoms: somatic, anxiety, episodic depression Syntonic: The defenses protect and hold onto the defenses
HIGH RESISTANCE WITH REPRESSION Severe early trauma: severe pain, rage and guilt Chronic or episodic severe depression Anxiety in smooth muscles Motor Conversion Self attacking tendency Syntonic defenses Need capacity building before facing the unconscious
Conscious Feelings Threshold to experiencing impulse/feelings Striated Muscle Anxiety Isolation of Affect Unconscious Anxiety Severe Repression Moderate Repression Mild Repression
Conscious Feelings 3 2 1 3 Striated Muscle Anxiety Isolation of Affect 2 Unconscious Anxiety 1 1. Pressure or Bracing 2. Rise in complex transference feelings and anxiety 3. Recap to bring isolation of affect
Guilt work as Capacities Rise Threshold to experiencing impulse/feelings Unlockings with Rage and Guilt: image transfer Immersive Technique: cognitive Guilt Muscle anxiety Graded Unlockings with some Guilt and UTA Links Recap and develop theoretical Guilt Guilt Rage Grief
Immersive Approach to Building Capacity Conscious Feelings 3 2 1 3 2 Striated Muscle Anxiety Isolation of Affect 1 Unconscious Anxiety 1. Pressure to experience rage 2. Rise to above threshold 3. Press to feel Guilt and regulate down anxiety as needed 4. Extensive Recapping
FRAGILE CHARACTER STRUCTURE PATIENTS Early neglect, abuse, invalidation Heavy pain, rage and guilt about rage along with craving attachment Cognitive-perceptual disruption at some level of rise in anxiety Projection, splitting, projective identification Need capacity building Change Anxiety to striated/voluntary muscle Change Defense to self reflection on feelings/isolation of affect
FRAGILE SPECTRUM Isolation of affect Striated Muscle Mild Fragile Severe Fragile Borderline Moderate Fragile
Economy of Suffering: Fragile Patients Anxiety Deception Masochism Paranoia Sadism: abuse power Somatization/ Paralysis Dependence/ Addiction Social Isolation No work or $$$ Dissociation Depression
TASKS IN TRIAL THERAPY: MILD FRAGILE CHARACTER STRUCTURE Establish Conscious Alliance Shared goals and tasks Show you know something and are competent Get Rise in the CTF::: Assess degree of fragility Assess what happens over threshold Do graded format: Recap and press Aim for first breakthrough to unconscious Explore some of history Wrap up and plan ahead
Conscious feelings 1. Pressure 2. Rise in CTF 3. Recap 3 3 12 2 1 Unconscious anxiety and defense Isolation of affect Striated muscle Mild fragile Severe fragile, borderline Moderate fragile
UTA RISES WITH CTF Conscious Feelings CTF UTA Unconscious Anxiety
Rapidly Rotating Fronts Cognitive Perceptual Disruption Self attack or seek punishment Projection: Afraid Repression: Flat, weak, depressed
MODERATE TO SEVERE FRAGILE CHARACTER STRUCTURE Isolation of affect Striated Muscle Mild Fragile Severe Fragile Borderline Moderate Fragile
PSYCHIC INTEGRATION With more severe fragility Linking things together so brain regions fire and function together Both triangles Between triangles Between parts of self Between superego, healthy self To have a single anxious person to work with
Immersive Approach to Building Capacity Conscious Feelings 3 2 1 3 2 Striated Muscle Anxiety Isolation of Affect 1 Unconscious Anxiety 1. Pressure to rage 2. Rise to above threshold 3. Press to Guilt and regulate down anxiety as needed 4. Extensive Recapping
Guilt about rage is repressed Feel rage about the attack or punishment Projection of rage or punishment Fear attack or punishment
UTA as Thresholds Rise Threshold to experiencing impulse/feelings R << UTA Rage and Guilt: image transfer R >> UTA Whispers from the alliance: concise understanding of dynamics R > UTA Negation, slips of the tongue R < UTA Rage, grief: clear linkages Guilt Rage Grief
