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In line with Luther's initial statement in his Large Catechism, some Lutherans speak of only two sacraments, Baptism and the Eucharist, although later in the same work he calls Confession and Absolution "the third sacrament." The definition of sacrament in the Apology of the Augsburg Confession lists Absolution as one of them. Luther went to confession all his life. Although Lutherans do not consider the other four rites as sacraments, they are still retained and used in the Lutheran church. However, in the nineteenth and twentieth centuries, private confession fell into disuse in many Protestant churches; at the present time, it is among Lutherans, for example, expected before partaking of the Eucharist for the first time. Philipp Melanchthon speaking about the Confession in the Lutheran Church, claims that "we do not wish to sanction the torture [the tyranny of consciences] of the Summists, which notwithstanding would have been less intolerable if they had added one word concerning faith, which comforts and encourages consciences. Now, concerning this faith, which obtains the remission of sins, there is not a syllable in so great a mass of regulations, glosses, summaries, books of confession. Christ is nowhere read there". This polemical view ignores the Catholic emphasis on faith and Christ in Catholic instruction and practice, including regarding confession.
The Catholic Church teaches that "Confession" is one name for the Sacrament, whereas another name, the "Sacrament of Reconciliation", highlights that it is an external expression of internal transformation. It is also the case that Confession is no longer regarded by some as the essence of the sacrament; they prefer to emphasise the aspects of healing and forgiveness. This aspect is of course included in the Catholic Catechism.
The basic form of confession has changed over the centuries. In the early history of the Catholic Church, confessions were made publicly, not only before the priest but also before the congregation. The Penitential Rite at the beginning of the Mass is a liturgical rudiment of this previously sacramental confession. This was discontinued, since for fear of shame it was thought that some might avoid public confession, and private confession became the normal way in which this sacrament was and is practiced, with a strict seal of secrecy on the part of the priest. Sometimes the practice of the sacrament emphasized doing acts of penance, sometimes it emphasized making one's sorrow or contrition authentic, sometimes it emphasized confessing all one's serious (mortal) sins, sometimes it emphasized the power of the priest to absolve the penitent of sin, and currently there are forms that include simply one-on-one confession to a priest or communal preparation and then one-on-one confession to a priest.
Guilt is an important factor in perpetuating Obsessive–compulsive disorder symptoms. Research is mixed on the possible connection between Catholicism and obsessive-compulsive symptoms. A study of 165 individuals by the University of Parma found that religious individuals scored higher on measures of control of thoughts and overimportance of thoughts, and that these measures were associated with obsessive-compulsive symptoms only in the religious participants. Another study noted a link between intrinsic religiosity and obsessive-compulsive cognitions/behaviors only among Catholic participants. However, a study from Boston University found that no particular religion was more common among OCD patients, and that OCD patients were no more religious than other subjects with anxiety. Religious obsessions were connected to the participants' religiosity, but sexual and aggressive symptoms were not. Greater religious devotion among OCD patients was correlated with increased guilt.
A study in American Behavioral Scientist analyzed interviews with participants from Catholic, Jewish, and Protestant backgrounds. The author reported that most participants "eagerly described an experience of guilt." 
University of Ulster students participated in a study that found a slightly higher level of collective guilt among the Catholic students than the Protestant students.
Researchers from the University of California at Berkeley and from the University of Notre Dame examined the concept of Catholic guilt among U.S. teenagers. The authors found no evidence of Catholic guilt in this population, noting that Catholicism both caused and relieved less guilt than other religious traditions. The authors found no evidence that Catholic teenagers experience more guilt than non-Catholic teenagers. The authors did not find that more observant Catholics feel guiltier than less observant Catholics. The study also noted no difference in the effect of guilt-inducing behaviors on Catholic versus non-Catholic participants.
A study from Hofstra University reported no difference in total guilt among religions, although religiosity itself was connected to guilt.
Guilt can be viewed in terms of constructiveness versus destructiveness: "constructive guilt" is focused on forgiving one's ethical lapses and changing one's behavior, while "destructive guilt" remains mired in self-loathing and does not emphasize learning from one's wrongdoings and moving ahead with life. A study in Psychology of Religion found that Catholic participants demonstrated a higher level of constructive guilt reactions than other groups.
Living in sin, with sin, by sin, for sin, every hour, every day, year in, year out. Waking up with sin in the morning, seeing the curtains drawn on sin, bathing it, dressing it, clipping diamonds to it, feeding it, showing it round, giving it a good time, putting it to sleep at night with a tablet of Dial if it's fretful. Always the same, like an idiot child carefully nursed, guarded from the world. 'Poor Julia,' they say, 'she can't go out. She's got to take care of her little sin. A pity it ever lived,' they say, 'but it's so strong. Children like that always are. Julia's so good to her little, mad sin.’ 
Jack Donaghy: That's not how it works, Tracy. Even though there is the whole confession thing, that's no free pass, because there is a crushing guilt that comes with being a Catholic. Whether things are good or bad or you're simply... eating tacos in the park, there is always the crushing guilt [Miming the act of self-flagellation].
Tracy Jordan: I don't think I want that. I'm out.[Jack crosses himself] 
[Jack turns to leave]
Jack Donaghy: [to himself] Somehow, I feel oddly guilty about that.