Early in my training in , my most important teacher, the legendary Professor, Dr. Elvin Semrad, made the following observation:

“Sometimes is simply guilt. But sometimes, guilt is resentment turned inside-out.”

I have found this distinction to be significantly useful. When my patient says that he/she is feeling guilty and depressed, I always consider the possibility that what is really at issue is resentment and .

The difference between guilt and resentment is an essential one, where potential resolution is concerned. The stubborn chronicity of guilt is painfully familiar, whereas awareness of the futility of resentment can evolve to acknowledgment of sadness. And sadness can be grieved and gradually overcome.

One of my adult patients (early 40's) suffers ongoing guilt that he would prefer to have as little to do with his aging father as possible — the consequence of the father’s severe limitations and constriction. His parents when their only child was age two, and he has had to manage the ongoing burden of his father’s expectations and wishes for filial .

Let’s consider the possibility that my patient is not acknowledging the resentment he holds toward his father, but knows only that he, himself, “feels guilty.” Does he dare to admit that he is resentful of his father’s remarkable self-centeredness? The clear futility of this resentment (he might as well resent the sun rising in the East and setting in the West) can allow acknowledgment of the underlying sadness that he feels at not having a father capable of real and loving connection. This sadness is painful, but a relief from self-blame and . Sadness allows compassion for oneself. And sadness yields. Grieving makes room for new life. The energy attached to what is NOT available becomes freed up to attach to something that IS available.

Guilt and self-blame can remain guilt forever.

Resentment can yield to sadness, compassion for self, grieving, and freed-up energy for renewed engagement with life.