The relationship between guilt, transference and personality in a sample of italian patients in therapy

Guilt is a complex and distressing emotion with multiple determinants that can be experienced in a variety of different situations (Gazzillo et al., 2017). It may be chronic or transitory, as well as conscious or unconscious, and it occurs when a person has done or feels to have done something wrong or when a person feels wrong and dangerous for being how s/he is (Albertsen, O’Connor, & Berry, 2006; Bush, 2005). If according to the psychoanalytical point of view guilt derives primarily from unconscious wishes to hurt others and stems from motives such as revenge, envy, jealousy and hatred (Freud, 1923), recent developments in biological, psychological and social sciences led to a redefinition of conscious guilt as an interpersonal emotion based on the need to maintain attachment and/or care relationships and group bonds (Baumeister, Stillwell, & Heatherton, 1994; Haidt, 2012; O’Connor et al., 2000). The first Freudian hypothesis about unconscious mental functioning fall within a model that may be described as an automatic functioning hypothesis (Weiss et al., 1986), because they conceive the unconscious psychic system (Unc) as a dynamic system characterized by drives seeking immediate relief and defenses that automatically oppose them. Within this model, psychic life is mostly driven by search for pleasure and avoidance of pain (Freud, 1911), where considerations concerning reality play a secondary role (Gazzillo et al., 2018). This higher mental functioning hypothesis, which Freud developed in some of his later works, perfectly matches recent findings of neurosciences and cognitive and evolutionary sciences, according to which the human mind is characterized by a series of conscious and unconscious processes, selected by natural evolution, that allow the individual to adapt to her/his environment (Huang & Bargh, 2014; Kenrick, 2011, Kenrick & Griskevicius 2013; Lewicki et al., 1992; Panksepp & Biven 2012; Wilson, 2012). According to the Control-Mastery Theory (CMT; Weiss, 1993; Weiss et al., 1986; Gazzillo, 2016), the human mind is “wired”, from the beginning of life, to adapt to reality, and in particular to interpersonal reality. To accomplish this, it needs to develop reliable knowledges, or beliefs, on how the surrounding environment works. Moreover, in order to survive a child needs to feel that the people caring for him or her are loving and protective, strong and happy. If this is not the case, the child will feel responsible for the parents’ lack of love and unhappiness, and guilty about having caused it or not having been able to ameliorate it. So, the child may develop a series of pathogenic beliefs that associate the achievement of personal well-being and the pursuit of healthy, realistic goals, with a fear of losing vital relationships or hurting people s/he loves and cares about (in other words, with anxiety and guilt). So, while classic psychoanalytic authors (Freud, 1923, 1924, 1939; Klein 1935, 1946) focused mainly on the intrapsychic origin of guilt and the demand for self-punishment due to perverse and destructive impulses, according to CMT the origin of guilt is interpersonal and adaptive, and stems from Fear, Attachment and Care affect systems (Gazzillo et al., 2018). Furthermore, interpersonal guilt may be the source of defenses, transference and self-sabotaging behaviors. Following this theory, guilt, thought as interpersonal and prosocial, may become dysfunctional when fed by pathogenic beliefs (erroneous assumptions that bring the person to associate the pursuing of a healthy and pleasurable goal with a danger) and it may be one of the organizers of transference. The patient may idealize, sexualize or devaluate his therapist; he may be worried about being a source of pain for his analyst, in the same way he was worried, once, about causing pain to his relatives (Bush, 2005). It is on these theorical bases that this research project is founded. The aim of this study is to empirically investigate the relationship between interpersonal guilt, transference and personality. The tools used in this study are: the Clinical Data Form (CDF; Westen, 1999), an anamnestic chart to collect information about patients and therapists; the Interpersonal Guilt Rating Scale- 15 (Gazzillo et al., 2017), and the Interpersonal Guilt Questionnaire 67 (IGQ-67; O’Connor et al, 1997) to assess interpersonal guilt of patient respectively from the therapist and the patient perspective; the Personality Relationship Questionnaire (PRQ; Bradley et al., 2005; Tanzilli et al., 2018) to assess transference; the Psychodynamic Diagnostic Prototype (PDP; Gazzillo et al., 2010), and the Personality Inventory for DSM 5 brief form (PID-5-BF; APA, 2013), to assess personality disorders/styles from both the therapist and the patient perspective. Preliminary analyses showed significant relationships between different kinds of interpersonal guilt, transference dimensions and personalities styles. First of all, we investigated the relationship between transference and interpersonal guilt with the Generalized Estimated Equations and we found positive and significative relationship between these constructs. Then, we repeated the model to see the relationship between these two variables and personality. For example, dependent personality disorder seems to be correlated with positive/working alliance, anxious/ preoccupied and sexualized transference dimensions. This personality disorder is also related to separation guilt, that is in turn related to anxious/preoccupied and sexualized transference dimensions. These results confirm the hypothesis that guilt and transference are connected and may be both considered expressions of personality. Future research will investigate the mediational role of guilt in the transference-personality relationship