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In response to Horwitz's critique (above) Bush asserts that the position of Weiss and his group is not that unconscious guilt is the primary cause of all psychopathology, but that irrational guilt and the defenses against it are important and frequently neglected determinants of psychopathology. Pathogenic grim unconscious beliefs not only create anxiety and unconscious guilt, they also form a context for perceived threats to the integrity of the self. Thus, they can motivate a broad range of defensive behavior. If one is careful to differentiate unconscious beliefs from unconscious fantasies, one sees that this new theory broadens and does not contradict the classical theory of neurosis or the more recent contributions of self psychology. It is essential in clinical practice to address the transference manifestations of a person's grim unconscious beliefs and their traumatic origins, to deal appropriately with the "tests" that represent the patient's unconscious efforts to mitigate these beliefs, and to understand and analyze the compelling psychic dangers against which patients defend themselves through their symptoms, inhibitions, and resistances. The author offers brief formulations of several common, difficult pathological conditions, and suggestions for therapeutic intervention in them.