‘Modern psychoanalysis’ developed by Spotnitz, offers an approach to understanding excessive self-criticism focusing on the role of bottled-up frustration–aggression in its aetiology and proposing treatment aimed at overcoming resistance to the expression of aggression. Modern psychoanalysis purports aetiology to be in the pre-Oedipal period when the infant fails to direct aggressive impulses outwardly. The result is the narcissistic defence in which the person directs aggression towards the self to preserve the object. Treatment is designed to promote the patient's psychological maturation by encouraging the appropriate expression of aggression towards the analyst in the transference, employing techniques such as emotional communication. Familial issues are often a significant contributing factor; reconciliations with an actual bad parent are encouraged in cases in which a constructive emotional interchange is beneficial. Two extended clinical illustrations are presented.