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The Utility of Regret in Psychodynamic Psychotherapy

James Tobin, Ph.D.

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What is Regret?

a negative cognitive/emotional state that involves blaming ourselves for a bad outcome

feeling a sense of loss or sorrow at what might have been

wishing we could undo a previous choice that we made

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The Work of Bronnie Ware

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The Top 5 Regrets Before Dying

1. I wish I had the courage to live a life true to myself, not the life others expected of me.

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The Top 5 Regrets Before Dying

2. I wish I didn’t work so hard.

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The Top 5 Regrets Before Dying

3. I wish I had the courage to express my feelings.

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The Top 5 Regrets Before Dying

4. I wish I had stayed in touch with my friends.

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The Top 5 Regrets Before Dying

5. I wish that I had let myself be happier.

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Regret and Gender Women seem to have more difficulty

disengaging from past relationships.

Overall, 44% of women surveyed had romantic regrets vs.19% of men.

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Regret and Culture Regret is much more commonly

experienced and reported to have more positive effects by young people in the U.S.

In contrast, people in collectivist cultures, which de-emphasize individual choice, have less of a basis for blaming themselves for negative outcomes.

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Regret and Time Proximally, people are more likely to

regret actions taken (commission) and mistakes made.

Distally, people are more likely to regret actions not taken (omission), such as missed opportunities for love or working too hard and not spending enough time with friends and family.

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The Insight Function of Regret

Neal Roese of the Kellogg School of Management at Northwestern University found that younger people rate regret more favorably than unfavorably, primarily because of its informational value in motivating corrective action.

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The Insight Function of Regret

Regret was rated highest of a list of negative emotions in fulfilling five functions:

(1) making sense of the world;(2) avoiding future negative behaviors;(3) gaining insight;(4) achieving social harmony;(5) improving one’s ability to approach

desired opportunities (regret often revolves around passivity or withdrawal).

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A Fine Line Regret has a learning/insight function.

It can also promote negative ruminations, depression, self-contempt, and a damaged self-esteem.

Anecdotally, most people have an

easier time forgiving others than themselves.

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If Only: Letting Go of Regret (Michelle Van Loon)

No Regrets: A Ten-Step Program for Living in the Present and Leaving the Past Behind (Hamilton Beazley)

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The Present Moment Numerous therapeutic interventions

are directed toward reducing the negative effects of regret (e.g., self-compassion and mindfulness approaches that emphasize the here-and-now).

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The Inherent Dualism of Psychotherapy: Affirmation vs. Insight

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“Dr. Tobin, Billy seems to be all smiles when he leaves your office ... I think your work with him is going very well.”

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Janet Landman, Ph.D. Regret, like grief, is transformed

by “working it through, which is lingering with it long enough to experience it deeply, emotionally and intellectually.”

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Review of Landman’s Book We are a people who do not want to keep

much of the past in our heads, " Lillian Hellman once wrote. "It is considered unhealthy in America to remember mistakes, neurotic to think about them, psychotic to dwell upon them." Yet who in their lifetime has never regretted a lost love, a missed opportunity, a path not taken? Although poets and novelists have long probed the complexities of regret, little has been written from a scholarly perspective.

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Book Review Now, in Regret: The Persistence of the

Possible, Janet Landman takes a lively and perceptive look at this perhaps universal experience. Landman addresses key questions about the nature of regret - what it is, how you experience it, how it changes you.

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The Paranoid/Schizoid and Depressive Positions

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“Magnolia” (1999; Paul Thomas Anderson)

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http://www.bing.com/videos/search?q=magnolia+film+clip+regret&FORM=VIRE1#view=detail&mid=3B03F40459EF16EC23223B03F40459EF16EC2322

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“Ali” (2001; Michael Mann)

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https://www.youtube.com/watch?v=NGFr0JCqxb4

 "Rumble in the Jungle” fight between Ali and Foreman in1971

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Imagine If George Foreman Started Therapy with You?

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How Is Regret Approached in Therapy and Used?

Regret is a psychic process involving conscious suffering, mourning, and assimilation; regret becomes a capability once it occurs and is processed in therapy.

It is an internal/intrapsychic achievement fostered by the “ ‘reciprocal resonance’ (Foxe, 2002) and intimate experience” (Kavaler-Adler, 2006, p. 342) the therapist and therapeutic situation offer.

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How Is Regret Approached in Therapy and Used?

Regret warrants a trauma approach designed to ultimately “forge a sense of self” (Buechler, 2009, pg. 435) in the patient.

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Foreman’s Looking Up at Ali: “Lived” Experience

In “Failure, Mistakes, Regret and Other Subjugated Stories in Family Therapy” (Journal of Family Therapy, 1996, p. 201), Spellman and Harper argue:

Their [White and Epston’s (1990)] conception of experience as it is ‘lived’ and as it is ‘storied’ may be of use in exploring how we, as practitioners, deal with failure and mistakes. They argue that we cannot have direct knowledge of the world except through our lived experience, but it needs to be given meaning ... [it needs to be] storied.

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Psychotherapy is the venue where lived experience has the potential to become storied.

As meaning and non-meaning emerge, one’s engagement with the world and with others is enhanced.

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The Psychic Process of Regret in Psychotherapy

A. Traumatic event (narcissistic injury) B. De-idealization and disintegration C. “Otherness” D. Contacting fate E. Atonement

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A. Trauma Lived experience and the regret it

prompts create a “split in ego continuity” (Shabad, 1987, p. 189).

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A. Trauma “When a traumatic occurrence creates a break, or what Balint (1979) called a ‘basic fault’ in ego development, we often see a compulsive urge to restore the relatively satisfying state prior to the trauma” (Shabad, 1987, p. 189).

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The Basic Fault: Therapeutic Aspects of Regression 

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A. Trauma The therapist must speak of the lived

experience as traumatic and anticipate directly to the patient his/her tendency to resist or deny it, or move toward repetition (regression) in order to defend against it.

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B. De-idealization and Disintegration

The idealized or fantasized self is fractured (“self-disgust”).

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B. De-idealization and Disintegration

One’s idealized self is disintegrated; many patients attempt to retain an idealized self by attempting to sequester the realized, disgusting self to an external appendage, i.e., “a tail,” “a mole,” etc.) they then try to remove.

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B. De-idealization and Disintegration

The therapist must emphasize the patient’s de-idealization and disintegration and validate the need for the sequestering.

Must avoid countertransferentially falling into platitudes, intellectualization, or rescue/feel-better interventions.

Must not accept the patient’s “it is what it is” and “everything happens for a reason.”

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C. “Otherness”

The other person or persons involved is/are formidable, unpredictable, and ultimately differentiated from the self.

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C. “Otherness”

Force of will, earnestness, and attempts to control, manipulate, appease or seduce are ultimately incapable of establishing the response desired.

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Shame C, in tandem with A and B, constitute

shame, in my view.

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Looping of A-B-C A, B, and C form a loop the patient may

perpetually repeat to resist the deep psychological processing and working through of regret (to inhibit assimilation).

The therapist tolerates the looping, bears the patient’s shame, and entertains the patient’s typical pursuit of rationalization, intellectualization, and, often, self-destruction, depression, and repetition.

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D. Contacting Fate Fate may be conceived as “a coldly

indifferent reality [that] imposes its necessities and limitations upon the individual; the hopeful wait for the realization of an impossible dream gradually gives way to a spiritless disillusionment” (Shabad, p. 197).

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D. Contacting Fate Meaning is, ultimately, only partial.

Reparation is not possible.

Humility emerges and represents the beginning of an erosion of pathological narcissism that continues across the lifespan.

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E. Atonement Being “at one,” i.e., an integration of

one’s self with the reality of experience.

This stage involves taking personal accountability along with the accurate recognition of what one is not responsible for and could not affect (this is “letting go” but also “holding on”).

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A Clinical Moment “Perhaps she would not have left you if

you hadn’t been talking to other women.”

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Suggested References Kavaler-Adler, S. (2006). From neurotic guilt

to existential guilt as grief: The road to interiority, agency, and compassion through mourning. Part II. American Journal of Psychoanalysis, 66, 333-350.

Kavaler-Adler, S. (2004). Anatomy of regret: A developmental view of the depressive position and a critical turn toward love and creativity in the transforming schizoid personality. American Journal of Psychoanalysis, 64, 39-76.

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Suggested References Shabad, P. (1987). Fixation and the

road not taken. Psychoanalytic Psychology, 4, 187-205.

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Questions/Discussion

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James Tobin, Ph.D. Licensed Psychologist PSY 22074220 Newport Center Drive, Suite 1Newport Beach, CA 92660 Assistant Professor of Clinical PsychologyThe American School of Professional Psychology at Argosy University

Email: jt@jamestobinphd.com Website: www.jamestobinphd.com 949-338-4388