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A confusion exists between the aims of psychotherapy of diminishing self-reproach, on the one hand, and increasing the experience of personal responsibility, on the other. In order to clarify this problem a distinction is made between moral responsibility, central to self-reproach, and psychological responsibility or agency. Self-reproach is shown to be inimical to the experience of psychological responsibility, with reference to psychotherapy of a case of severe obsessive self-reproach.
People who constantly reproach themselves are usually considered to have an excessive sense of personal responsibility. They feel responsible even for failures or mistakes that are obviously beyond their capacity to avoid. It is generally the aim of psychotherapy to diminish such self-reproach and the exaggerated sense of responsibility it seems to be founded on. Yet, psychotherapy is also thought to have what seems a contrary aim, namely, to increase the patient's experience of responsibility for what he or she does (Kaiser, 1955, 1965; Shapiro, 1989), or agency. Neurotic patients regularly tell us that they do things they really don't want to do, that they continue relationships they get nothing out of, and that they somehow don't do what they're sure they actually want to do. This is the sort of thing we mean when we say that the neurotic personality is not well integrated. If psychotherapy is successful, it is said to diminish that kind of self-estrangement, so that the individual knows more clearly what he or she wants and wants to do, and in that sense experiences more clearly their responsibility for what they do. Evidently there are two different kinds or meanings of responsibility here-the kind that therapy aims to diminish and the kind it aims to expand-and two different kinds of subjective experience. For convenience I will call the kind of responsibility contained in self-reproach the moral sense of responsibility and its alternative the psychological sense of responsibility.
These two are certainly different, but they are not entirely different. The reality of volition and personal choice is central to both ideas of responsibility, but their conceptions of volition and choice are quite different. There is also a definite relation between the two kinds of experience of responsibility, actually a dynamic relation. They are in conflict with one another. To the extent...