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Psychoanalysis On and Off the Couch

Feb 21, 2021

"Persecutory guilt is simply a form of self-attack, it is tormenting and it belongs to the paranoid schizoid position and it is narcissistic. People sometimes don’t fully recognize the narcissism in the paranoid-schizoid position, because it is in that position you are feeling hunted by predators… When we're in the depressive/reparative position other people are real to us, we not only are able to empathize with them we need to go beyond empathy to sympathy in the depressive position where I not only know how you feel, but I care and I wish to relieve your pain."


We discuss the differences between guilt that reflects concern for the other and alternatively self-abuse that serves narcissistic purposes. The former relates to Klein's depressive/reparative stage, labeled ‘conscience’ by Carveth, and the latter derives from the paranoid/schizoid position, labeled ‘superego’. We review varying technical approaches to each of these clinical presentations and note that the countertransference provides vital guidance in understanding the state of the analysand's mind. We close by considering how the capacity to bear guilt may be a measure of the maturation of a civilization.


Our Guest:

Donald L Carveth, Ph.D., RP, FIPA is Emeritus Professor of Sociology and Social & Political Thought at York University in Toronto. He is a Training and Supervising Analyst at the Canadian Institute of Psychoanalysis, past Director of the Toronto Institute of Psychoanalysis, and past Editor-in-Chief of the Canadian Journal of Psychoanalysis/Revue Canadienne de Psychanalyse. He is the author of The Still Small Voice: Psychoanalytic Reflections on Guilt and Conscience (Karnac, 2013) and Psychoanalytic Thinking: A Dialectical Critique of Contemporary Theory and Practice (Routledge, 2018). He is in private practice in Toronto.

Many of his publications are available at

His video-lectures on psychoanalysis may be found at


Recommended Readings:

Sagan, E. (1988). Freud, Women, and Morality: The Psychology of Good and Evil. New York: Basic Books.


Carveth, D. (2013). The Still Small Voice: Psychoanalytic Reflections on Guilt and Conscience. London: Karnac.


Carveth, D. (2016). Why we should stop conflating the superego with the conscience. Psychoanalysis, Culture & Society Vol. 22, 1, 15–32.