Unconscious guilt as a cause of sexualized relationships.

The author summarizes 4 years of intensive psychotherapy with a patient who engaged in various forms of self-destructive behavior, including the sexual fondling of his 14-year-old stepdaughter. The author illustrates the important role that unconscious guilt may play in motivating a patient to engage in what ordinarily would be thought of simply as illicit drive-gratifying behavior. She describes the patient's reported childhood traumas and the therapeutic process of treatment, and gives examples of interpretations that facilitated the patient's efforts to gain control over his self-destructive behavior.