Bearable and unbearable guilt: a Kleinian perspective

Material is presented from four analytic sessions with a patient who seems unable to bear guilt. The first two illustrate defenses against guilt; the last two show the incipient experience of guilt and, finally, the ability to suffer conscious guilt. The author questions interpretations that address defenses against guilt but fail to help the patient bear the guilt. Such interpretations can make the analyst prey to a sadomasochistic enactment in the transference whereby the patient expiates the guilt and reverts to not recognizing what he or she does to objects. The ability to bear guilt is increased by a diminution of the patient's destructiveness and by the mobilization of love.