Abstract

Effective treatment of disorders of agency presents a clinical conundrum. Many of the core symptoms or maintaining factors are actions and omissions that cause harm to self and others. Encouraging service users to take responsibility for this behavior is central to treatment. Blame, in contrast, is detrimental. How is it possible to hold service users responsible for actions and omissions that cause harm without blaming them? A solution to this problem is part conceptual, part practical. This chapter offers a conceptual framework that clearly distinguishes between ideas of responsibility, blameworthiness, and "detached" and "affective" blame. It argues that affective blame is detrimental to effective treatment. And it suggests that affective blame can be avoided by attention to service users' past history, which directly evokes compassion and empathy. Finally, the chapter briefly considers whether the clinical stance of responsibility without blame should be adopted in non-clinical interpersonal and social contexts.