Erotic Transference and Projection

A patient, after exploring feelings, says she feels over-attached to the therapist and is angry with herself for such “stupid” feelings. How should we intervene? If transference feelings are based on projection, do we need to block her projections and work on reality testing or should we focus on the underlying feelings toward the therapist?

Everybody projects. Fragile patients project feelings onto others to avoid the conflict between love and rage internally. Since their projections are accompanied by cognitive/perceptual disruption, and a loss of reality testing, we have to restructure their projections to re-establish reality testing. Then we help them face the feelings inside without projecting them outside onto others.

Patients who use the resistance system of repression may project, imagining the therapist is critical of them. Very quick work to establish reality testing suffices, and then we invite feelings toward the therapist to block the projection and increase the patient’s capacity to bear mixed feelings toward the therapist without resorting to self-attack.

Patients who detach, using the resistance system of isolation of affect, also can project but without a loss of reality testing. Thus, their projections do not usually have to be restructured. Instead, we block those projections, treat them as thoughts, and invite the patient to face the feelings toward the therapist that are underneath those thoughts.

In this case, the patient mentions her erotic feelings, and then resorts to the defense of self-attack. Thus, we would hypothesize that she has both loving and angry feelings toward the therapist. The loving feelings she can admit; the angry feelings she turns upon herself to protect the therapist. This is the strategy for handling mixed feelings in the resistance system of repression.

Pt: “I feel love for you, but it is so stupid of me.” [Self-attack: repression]

Th: “Could this be a critical thought? Could this thought be hurting you? If we look underneath the critical thoughts could we see what feelings are coming up here toward me?” [Identify the defense, clarify its price, and ask for feelings toward the therapist so the rage will be directed outward onto the therapist instead of inward upon the patient.]

Pt: “I told you I love you.” [No sigh, indicating defense.] [Often, the patient shares with you the feelings that don’t arouse anxiety. Always accept them, and then ask for the other feelings that trigger the anxiety.]

Th: “Yes, you have positive feelings here toward me. But if all you felt were positive feelings, we wouldn’t see this anxiety and the critical thoughts. I wonder what other feelings in addition could be making you anxious. What other feelings are coming up here toward me?”

Pt: [Sigh] “Feeling toward you?”

Th: “Yes. What feelings are coming up here toward me, if we look underneath the critical thoughts? What feelings are coming up here toward me?”

Pt: “I feel irritated that I am telling you these things and you don’t tell me what you feel.” [The patient now intellectualizes about her anger rather than turn it upon herself: a small piece of progress.]

Th: “So how do you experience that irritation here toward me?

Pt: [sigh]

In this case, the patient is not projecting upon the therapist. As she shares more with him, they become more emotionally close. This triggers mixed feelings toward the therapist. To protect the therapist from her anger, the patient turns the anger upon herself and shows only her love toward him.

The therapist encourages the patient to reveal her mixed feelings. He accepts the positive, loving feelings, and encourages the patient to share the other feelings that trigger her anxiety. As a result, she does not have to hide her rage under her love, sexual feelings, or a sexualized transference.

Through this process, the therapist helps the patient face her mixed feelings of love and rage that come up toward the therapist. Then he helps her face these mixed feelings at progressively higher levels without resorting to self-attack. Once she can face 100% of her feelings without self-attack, the resistance system of repression has been restructured.

Problems working with guilt

When patients experience their unconscious rage in therapy, they often do not experience their love and guilt. Why? Also, how do you work on anxiety when it goes too high during guilt work? What defenses do you look out for and how do you work with them? Why doesn’t guilt and love come through?

Thanks to Reza for these questions!

In all therapy relationships, mixed feelings rise toward the therapist, feelings based on the patient’s previous experience. Love arises because the patient wants to connect. Rage arises because previous connections hurt the patient.

Those mixed feelings trigger anxiety and defenses, which create the patient’s presenting problems. So the therapist helps the patient see and let go of those defenses to face the underlying feelings that have been driving a pattern of self-punishment through defenses.

To do this, the therapist explores feelings in a current, past, or therapy relationship. As the therapist helps the patient face and let go of defenses, often anger is the first feeling to break through. Once the anger breaks through to someone we love, however, guilt arises. Why? The rage is felt toward someone we love. That combination of love and rage toward the same person triggers guilt.

To avoid the anxiety triggered by the love and guilt, the patient may use defenses such as denial or devaluation. In my book, Co-Creating Change, (chapter on breakthrough to the unconscious) you will see how I suggest you work with sixteen different defenses that arise at that very moment, defenses that will prevent the breakthrough of the love, guilt, and grief.

However, sometimes the patient begins to experience the love, grief, and guilt, but has trouble bearing these powerful emotions and becomes overwhelmed with anxiety. If so, cognize about the anxiety briefly, make the link to the guilt, and build the patient’s capacity to bear this much guilt without becoming overwhelmed with anxiety.

Th: Notice how you are becoming dizzy? So we see that as soon as we touch on this guilt, you become anxious, and then your mind becomes dizzy. See that?

Pt: [sighs or tenses up] Yes.

Th: So what does you father’s face look like as you see what you did to him? [Explore images that will trigger higher levels of guilt so you help build the patient’s capacity and enable him to have a fuller unlocking of his unconscious.]

We call this a “pocket of fragility”. The patient is temporarily too anxious, but a brief summary is enough to regulate anxiety and we continue to go for as high a rise of feelings as the patient can manage.

Why don’t guilt and love come through after the rage? Defenses or anxiety block the way. Why?

Sometimes the therapist goes for a premature breakthrough before having explored feelings long enough to mobilize the unconscious enough to have a breakthrough. I have seen therapists go for a breakthrough after asking for feelings only three times…instead of after twenty or thirty minutes!

Sometimes the patient has shifted from resisting feelings to resisting emotional closeness. Thus, the patient is distancing from the therapist with a transference resistance. If the therapist does not see this, no breakthrough will be possible. See my earlier blogs on signs of the emerging transference resistance.

Sometimes the patient’s resistance is in the system of projection or repression where further restructuring is necessary before a breakthrough to complex feelings would be possible, or even advisable! Premature breakthroughs with these groups of patients can lead to regression or depression.

Sometimes the therapist does not recognize the defenses which are preventing a rise of unconscious feelings. If we address the wrong defenses, the unseen defenses will block the way. That’s why having an expert look over your videos is essential. He or she can help you see what you need to do to help the patient further.

If love and guilt do not arise after a breakthrough to rage, look for the defenses that are getting in the way. If you help the patient feel only rage, without her love and guilt, we only help her get better at denying her humanity through denial, detaching, projecting, or devaluation. Experience of rage by itself is almost never helpful. Our task is to help the patient embrace the fullness of her humanity: her rage, her love, her guilt, her grief, and her wish to connect.