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In our reply to these essays, we make a number of points, among which the most important is that any psychoanalytic interpretation or intervention is premised on tacit notions about the social world in which the individual patient lives. It is also premised on notions about the actual possibility of changing that world, and notions about the means by which change occurs. Some therapy discussed here seemed to us based on various versions of First World guilt. When a patient feels guilty, it often suggests that he or she is acknowledging that something about a larger social arrangement is deeply wrong. This is an important first step. But such guilt can also act as a sort of short-hand personalistic substitute for socially organized change, as if to say, “Let me be the sacrificial lamb.” And if one sacrificial lamb lets the rest of the feast go on as is, the goal of social change is not accomplished and is often lost to sight.