Am I missing signs of anxiety?

“I have a patient, who voices his anger towards loved ones, but I rarely see any signs of anxiety and have never seen him sigh. At times he shifts in his chair, and sometimes he has dry mouth. But most of the time there is no sighing. What should what I do if the patient voices his anger without any signs of anxiety. Am I missing some signs of anxiety?” Great question!
If a patient voices his anger but is not sighing, either the anger is a defensive affect or the patient is using one of the systems of resistance. For instance, he might say he is angry, split off his positive feelings, and feel only rage toward someone, so no anxiety would rise. Remember that anger by itself does not trigger anxiety. Anger plus love mobilizes guilt which triggers anxiety.
Or he might feel angry and then turn it on himself. Then his anxiety would go into the smooth muscles, not the striated muscles. He feels only love toward you because he turns the rage back onto himself.
Or he might detach and intellectualize and detach from you. His detachment his feelings and from you would prevent feelings and anxiety from rising. Thus, we would not see a rise in unconscious anxiety in the form of sighing
So the question becomes this: when the patient does not sigh, which system of resistance does he use? 1) isolation of affect (detaching from you); 2) repression (turning anger upon himself); or 3) projection and splitting (splitting off loving feelings, feeling only rage, thus no anxiety rises).
When he does not sigh, notice what his next verbal response is. That defense will tell you the system of resistance you need to treat. If he looks away and detaches, that is isolation of affect. If he becomes depressed and weepy, engages in self-attack, or somatizes, that is the system of repression. If he projects onto you or others or views others as all good or all bad, then he is using the resistance system of projection and splitting.
Take home point: if you see no sighing, ask for feelings, notice the defenses, and then determine the system of resistance that is preventing a rise of complex mixed feelings. Now you will know why unconscious anxiety is not rising in the body.

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