‘Survivor guilt’ is commonly referred to in clinical settings and in popular culture, however the phenomenon has largely been neglected in trauma-related research. There is a scarcity of research on its phenomenology and underlying mechanisms, and there are no published studies to date that investigate treatment options for survivor guilt after trauma. This study set out to explore the lived experience of how individuals interpreted and made sense of surviving when others had died with a view to gain a better understanding of survivor guilt and factors associated with it. A qualitative methodology was employed. Six participants that had survived a traumatic event where others had died and who were currently in therapy for PTSD were interviewed. Interpretative Phenomenological Analysis was used to analyse the interview data. Results were grounded in interview data from the six participants, prioritising their own accounts of the experience. The results derived a theoretical model showing participants in a never-ending dynamic of making sense of why they survived when others died. Central to this model was persistent guilt about surviving and a sense of disentitlement to life (which could be conceptualised as shame) driving internal processes associated with sense-making and external processes associated with reparation. Examples from the interviews illustrate each component of the model. Similarities and differences between participant experiences are also highlighted. The theoretical model is discussed in relation to existing literature.