Shirah Vollmer MD

The Musings of Dr. Vollmer

Parental Guilt

Posted by Dr. Vollmer on November 29, 2012

“I want you to know we have a normal family,” Maureen says to me, as she admits her twelve-year old to the psychiatric hospital for serious substance abuse issues. I did not ask her about her family, so her comment made me pause. You mean, you feel very guilty, I wanted to say, but I did not have the history with Maureen which would have enabled me to speak my mind. “Parental guilt is overwhelming,” I say to my students, thinking about Maureen. “Parents feel guilty, generally speaking, no matter what happens to their children, and when this guilt is added on to things they really feel they did wrong, then they have guilt squared,” I say, trying to explain that a part of parental guilt is about understanding the enormous  responsibility of another human being, whereas another part of guilt could be a knowing negligence when it comes to parenting. “When the guilt can come to the light of day, parents often feel uniquely understood,” I say to my students. “No one wants to talk to them about their guilt. Most well-meaning friends and family want to jump in and quickly reassure the mom that she did the best she could.” I say, emphasizing that the role of a mental health professional who works with children and families, is to demonstrate the understanding of the really difficult feelings which can bubble up during a mental health crises. Reassurance does not help because the parent often feels like their friends do not really understand how deeply bad they feel. Further, the loved ones often do not want to acknowledge the depth of the guilt because it can trigger in the listener their own sense of guilt towards their children. “The default assumption, until you get more information, is that the parent is feeling guilty when they see you.” I say to my students who are  rookie child psychiatrists. “Probing for that guilt is the art of our profession,” I say, thinking to myself that in some ways, this is a lost art, but also hoping that maybe, I and many of my colleagues, are slowly bringing this art back to the field. “No one wants to feel guilty, but worse than that, no one wants to feel alone in their guilt.” I say, pointing out that feeling misunderstood is worse than feeling guilty. “Understanding guilt is tricky, because you need to empathize without agreeing or disagreeing with their own sense of negligence.” I say, emphasizing that understanding guilt is a challenge.  “I hear you,” I respond to Maureen, acknowledging that I hear her statement about her family, but I am also hinting that I understand that there could be a subtext.


2 Responses to “Parental Guilt”

  1. Shelly said

    Since I assume that Maureen’s 12-year old daughter is your patient and not Maureen herself, that is the reason why you cannot speak to Maureen about her feelings of guilt. If she were seeing you for parental instruction, would you speak to her differently than if she were there for individual therapy? If Maureen wanted to feel understood or not alone in her guilt, why couldn’t you at least acknowledge that you understood her situation? Hearing that she expressed that her “family was normal” and understanding what she was trying to say–to Maureen, seemed very important. Is it important to remain balanced and not seeming to “take sides” between parent and child (i.e. not agreeing or disagreeing with their own sense of negligence)? What do you do with the enormous amount of guilt parents constantly feel about the children’s sometimes damaging choices (i.e. drug and alcohol abuse, etc…)?

    • Shirah said

      The issue of who is the patient is always complicated in child psychiatry, since the child is part of a larger system. The issue is that I don’t know Maureen well enough to understand how she will process my feedback. This understanding takes time. Yes, the “therapeutic contract” is an important issue. That is, what is Maureen’s understanding of my role? Understanding the guilt is the first step. Ultimately, forgiveness needs to happen, but this is only valuable if the understanding is deep. THanks.

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