Guilt and feelings of guilt play an important role in human development and behaviour and especially in the development of psychopathology. In our daily life and in our therapeutic practice we are regularly confronted with these powerful feelings and the causal role they play in producing a variety of symptoms, inhibitions or maladaptive character traits. In this paper the author differentiates between real guilt and irrational feelings of guilt. He describes how irrational and pathological feelings of guilt stem from distorted, unconscious thoughts and beliefs about having hurt or doing something hurtful to someone for whom one feels responsible. Hirsch (1997) differentiates feelings of guilt as follows: a basic feeling of guilt, b feeling of guilt coming from vitality, c feelings of guilt caused by separation, and d traumatic feelings of guilt. The different feelings of guilt are discussed and illustrated by vignettes. Finally the author describes the role unconscious feelings of guilt can play in the therapeutic process and how the therapist can help the patient to master these feelings.

A changing health care market requires the development of new forms of treatment in mental health care. Government and care institutions believe that eHealth is the ultimate answer to the many problems with which the health care is faced. eHealth must satisfy the quality parameters which insurances and care providers request: care must be effective, efficient, accessible and cost effective. For mild mental problems eHealth is an effective treatment method. For more complex disorders this is less clear, but there are numerous indications that it can support effectively traditional face-to-face treatment. Nevertheless this form of treatment is still insufficiently accepted by the patient. Several reasons are discussed and some recommendations are made to turn eHealth in the mental health care into a success.

In this article a description is given of two clients of a specialized psychiatric outpatient clinic. Both are eldest daughters (68 and 82) who attracted attention because of their comparable problems and particular parallels in their life stories. They developed a caring attitude in youth which they continued in adulthood. This attitude appears to have become part of their personality: caring for others has priority above caring for themselves. Parentification in their early lives might explain their clinging to care for others in their adult life. This attitude puts them at risk for developing psychiatric problems in later life, when they are not able to offer their care anymore, or when their care is not needed any longer. Implications for treatment are given.