Part of moving past self-blame is asking the right questions

It is relatively common for people who have had some sort of traumatic experience to blame themselves for the event, even when it is clear they did not cause it.  Some of these individuals readily acknowledge that they did not cause the event to occur; still, they hold themselves responsible for not preventing it.  This is especially true when they can look back on the event and identify things they could have done differently that would have led to a better outcome.

Self-blame creates a lot of emotional suffering.  This leads me to conclude that people do not choose self blame; in fact, many people attempt to convince themselves of their innocence.  Barring that, they might try to avoid thinking about the event at all.  Paradoxically, they find that no matter how hard they try not to think about the event they seem to think about it all the time.  In turn, these unwanted thoughts remind them of their guilt.  In this way, self-blame begins to consume more and more of their lives.

So how do you help someone overcome self-blame?  It is not enough to tell them that they've done nothing wrong; they've probably heard this a million times already.  There is very little anyone can say to convince them of their innocence; this is a conclusion they must reach on their own.  As a therapist, I try to operate from the assumption that the patient has the answers; my job is to ask the right questions.

So what kind of things might I ask about?

What happened? It's important for me to have at least a basic understanding of what took place.  For one thing, it helps to distinguish between appropriate and inappropriate guilt.  There is always a possibility that the patient did in fact commit some act of wrongdoing.  In such cases, the task is for the patient to learn to forgive himself.  Either way, I need to know the basic facts in order to help the patient put the event in its appropriate context.  If relevant, I sometimes ask patients to draw a little diagram so I can get an idea of the environment where the event took place and of where the patient was positioned in relation to other people.  (You'd be surprised by how helpful this can be.  Sometimes a diagram makes it immediately apparent that, for example, based on the patient's position in relation to others there was no way he could have caused, prevented, or otherwise intervened in the event). 

If you went before a jury, would they find you guilty and convict you of causing the event?  What specifically would they convict you of?  This helps people to think about guilt from a different perspective by adopting the mindset of a hypotehtical jury member who has been instructed to consider only the facts.

Are you the only one to blame for the event?  Or are there others who bear some responsibility?  I often have patients make a "responsibility pie chart."  I ask them to identify all of the people (or other entities) who played some role in causing the event and to assign a percentage of total blame to each one.  (Remember, the total has to add up to 100%).  Ultimately, most patients end up assigning themselves somehwere around 20 to 25% of the total "blame."  I then ask: "Are you treating yourself like you're 25% responsible?  Or are you treating yourself like you're 100% responsible?"

Do other people share the belief that you are to blame?  If not, who do they blame?  How did they reach this conclusion?  What evidence did they use?  Is this the same evidence you use? 

If a friend or relative had a similar experience, would you blame them?  If not, why?  Are you holding yourself to a different standard? 

These are just a few of an endless number of possible questions...