Dr. Carveth discusses the differences between guilt that reflects concern for the other and alternatively self-abuse that serves narcissistic purposes. The former relates to Klein's depressive/reparative stage, labeled 'conscience' by Carveth, and the latter derives from the paranoid/schizoid position, labeled 'superego'. We review varying technical approaches to each of these clinical presentations and note that the countertransference provides vital guidance in understanding the state of the analysand's mind. We close by considering how the capacity to bear guilt may be a measure of the maturation of a civilization.