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Along with narcissistic vulnerability and related affects of shame, helplessness, and reactive anger, conscious or unconscious guilt often cripples depressed patients. Some patients reveal deep-seated feelings that they are bad or unworthy and are prone to attacking themselves—through self-criticisms or punishments—when they sense that they are behaving in an aggressive, competitive, or overly sexual manner. Examples of this are the cases of Ms. G in Chapters 4 (“Getting Started With Psychodynamic Treatment of Depression”) and 6 (“Addressing Narcissistic Vulnerability”), who felt devastatingly guilty about aggressive thoughts concerning her mother and boyfriend, and of Ms. V in Chapter 7 (“Addressing Angry Reactions to Narcissistic Injury”), who worried that she was harsh when expressing vindictive feelings toward her father.
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