Draining the Pathogenic Reservoir of Guilt? : A study of the relationship between Guilt and Self-Compassion in Intensive Short-Term Dynamic Psychotherapy

Abstract: Objective: One of the main theoretical proposals of Intensive Short-term Dynamic Psychotherapy (ISTDP; Davanloo, 1990) is that experiencing of previously unconscious guilt over aggressive impulses associated with attachment trauma leads to increase in self-compassion. The present study aimed to test this assumption. Method: Videotaped sessions from five therapies from a randomized controlled trial of 20-sessions of time-limited ISTDP for treatment-refractory depression were rated with the Achievement of Therapeutic Objectives Scale (ATOS; McCullough, Larsen, Schanche, Andrews& Kuhn, 2003b). Degree of patient guilt arousal and self-compassion were rated on all available sessions. Data were analyzed using a replicated single-subject time-series approach. Results: Guilt arousal was not shown to positively predict self-compassion for any of the five patients. For one patient guilt arousal negatively predicted self-compassion two sessions ahead in time. Conclusion: The current study yields no support that the experience of guilt over aggressive feelings and impulses leads to increases in self-compassion. On the contrary, the finding that guilt negatively predicted self-compassion for one patient must be considered as an indication that this treatment process might negatively impact self-compassion for some patients in some contexts. However, there are several methodological limitations to the current study in the light of which the results should be regarded as tentative.