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Section 1
Track #1 - Tools for Moving Beyond Guilty Feelings of 'I hate myself!'

CEU Question 1 | CEU Answer Booklet | Table of Contents | Introduction | Grief
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In my practice, I have defined two distinct types of guilt.  On this track, we will discuss these two distinct types of guilt, which are: unrealistic guilt and realistic guilt.  As I describe these two types of guilt, think about Guilty Feelings old woman sad Grief Treating LifeTrauma mft CEUhow you might use the ideas with clients you are treating.

Two Types of Guilt

Share on Facebook #1 Unrealistic Guilt

The first type of guilt we will discuss is unrealistic guilt.  As you know, grieving clients often blame themselves when they experience loss.  See if your self-blaming client is experiencing unrealistic guilt like Anna.  Anna, age 48, had been providing medical care to her father, John, in the six months before his death.  Anna stated, “Dad always said he didn’t want to die in a hospital.  So when he got cancer, I wanted to make sure he could stay at home.  But I should have been with him.  If I had known it was his final day, I would have taken off work.  I’m such a horrible daughter! I hate myself!” 

Though clients may genuinely feel blameworthy, usually self-blaming guilt is unrealistic.  Do you agree?  I stated to Anna, “Have you ever considered that you are being overly harsh with yourself?  It sounds like you’re stretching your imagination to believe you are responsible for anticipating or preventing events that you could not possibly have prevented.”  Through unrealistic guilt, Anna felt as if she had intentionally brought harm to her father

Anna identified other examples of the unrealistic guilt which she had experienced by stating:
-- “If I had been home the day Dad died, maybe he could have pulled through.” 
-- “If only I had rented a more comfortable hospital bed, he would have felt more at home.”
-- “Maybe if I hadn’t focused on work so much he could have died feeling loved.” 

As you know, in the early stages of grief, arguing against unrealistic guilt is not productive.  I usually feel at some point unrealistic guilt needs to be addressed.  In a later session with Anna, I stated, “If you had been able to act differently, then you would have acted differently.  It’s not in your power to anticipate everything perfectly.”  By listening attentively for signals of unrealistic guilt it was possible to help Anna recognize how she was blaming herself unnecessarily.

Share on Facebook #2 Realistic Guilt
In addition to unrealistic guilt, we will also discuss realistic guilt.  Clients generally blame themselves in situations of genuine negligence.  Therefore, if a client’s careless behavior causes another person to suffer, the result is realistic guilt. 

For example, Robert, age 38, had given his son Peter a BB gun for his birthday.  Robert stated, “I set up a target on the side of the garage for him to shoot at.  I should have thought about a possible ricochet, but instead I just left him there to shoot on his own.  Peter came in later crying ‘I’ve been shot!’  There was a lot of blood, so I called 9-1-1.  Poor Peter had actually shot his eye out.  Now the kid is walking around with a glass eye.  What kind of father am I?” 

Robert’s feelings of guilt are realistic because he was responsible for Peter’s accident with the BB gun.  I stated to Robert, “You are right to feel guilty about the accident.  However, there is no need to punish yourself, though, Robert.  It was an accident.”  In Robert’s situation of realistic guilt, I found that by listening to him express his feelings and reinforcing the idea that he did not intentionally harm his son, I could help him forgive himself. 

Share on Facebook 4-Step Moving Beyond Guilty Feelings Technique
To help Robert, as well as Anna who felt unrealistic guilt over her father’s death, I implemented the “Moving Beyond Guilty Feelings” technique. 

--The first step in this technique is to identify as many guilty feelings as possible.  I asked Anna to make a list of all the “if” statements she could think of.  As you know, “if” statements are part of the vocabulary of grief clients.  Anna’s “if’ statements included  “If I had been home the day Dad died, maybe he could have pulled through.”  “If only I had rented a more comfortable hospital bed, he would have felt more at home.”  “Maybe if I hadn’t focused on work so much he could have died feeling loved.” 

--The second step is to analyze the “if” statements with the client for content.  Some questions I asked Anna were, “Is this statement realistic or unrealistic?”,   “Could anyone else have done what you wish you had done?”, and “Do you believe the statement to be true?”  Anna’s answers indicated she was beginning to distrust her unrealistic guilty feelings. 

--The third step in the “Moving Beyond Guilty Feelings” technique is to prompt the client to dispute any unrealistic guilt.  With Anna, the second and third steps ran together as her answers to my questions were elaborate.  You may find, as I did with Anna, that as the client identifies and lists guilty feelings, he or she may begin to analyze and dispute those feelings naturally.  

--The fourth step is to ask the client to write down new feelings to replace the guilty feelings.  For example, Anna wrote ‘Dad was happy he did not have to die in a hospital’ and ‘Dad knew I cared for him very much.’ 

On this track, we discussed feelings of guilt.  In my practice, I have defined two distinct types of guilt.  They are unrealistic guilt and realistic guilt.

On the next track, we will discuss the Relationship Inventory technique.  The three types of relationships are pre-trauma relationships, relationships during the trauma, and post-trauma relationships.

Online Continuing Education QUESTION 1
What are two types of guilt? To select and enter your answer go to CEU Answer Booklet.

 
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