Category Archives: General

In Touch with Anger

Recently a patient of mine brought a situation to understand his being in touch with his anger and yet his feeling low thereafter. He was watching a live cricket match with his brother, and his brother’s wife walked in and changed the channel without saying anything to either one of them. When the channel was changed the patient was upset and walked away from the room as he thought saying anything would worsen the situation. Of course he was angry he said, and he wanted to shout at her. He was easily able to identify his feelings. But then he says he went to his room and started to read his book and that he was feeling very low (could this be because he did not allow to feel his anger physically in his body? And how could one help him in doing so?) He did not like it (naturally). His question to me was should I have told my sister in law that her behavior made him angry?  And in spite of the fact he was in touch with his feelings why was he still feeling low?  And what could he do in similar situations next time?

Here, the patient felt anger and used the following defenses: walking away from his anger, detaching, getting depressed (feeling low), rejecting his feeling (I don’t like it.) These offer different opportunities to intervene: “When you felt angry you wanted to walk away from it. If we take a look at this anger instead, how do you experience this anger toward her?” “Rather than feel your anger, you tried to detach by reading a book. Can we take a look instead at how you experience this anger toward her?” “So after you got angry with her, you started feeling low and depressed. If we look under the depression, how do you experience this anger toward her?”
You mention he was “in touch” with his anger when he was low. I doubt it. I suspect that he could cognitively label the feeling anger, but that when he was low, he was feeling depressed instead of experiencing the feeling of anger in his body. Rather than feel angry with his sister in law, he turns the anger onto himself and gets depressed.
Saying he feels anger (verbal label) is different from experiencing his anger physically in his body.
“Should I have told her I am angry?” he asks his female therapist, inviting her to become another woman who takes control of his life Therapist response: “Only you can know how you would like to deal with your anger.” This blocks his projection and keeps you from stepping into the shoes of another “dominating” woman.
Then you can continue, “Perhaps the issue right now is not what to say to her, but to take a look at the anger you feel toward her because we notice that rather than feel your anger, you become depressed instead. Would you like us to take a look at how you experience this anger physically in your body right now?”
As you explore, he will either become a little depressed or he will detach. If he becomes depressed, note his depression and then ask for the feelings under the depression: the feelings toward you. If he detaches, note how he detaches from you and ask what feelings he has toward you that make him detach from you. Then you will be addressing his problems as they manifest right here, right now, in the relationship with you.
2) the patient has a hard time to enact his murderous rage. Each time he does it he would say how the other person would try to restrain him from carrying out his rage.  could this be a sign of a very harsh superego where he cannot allow himself even in fantasy to enact his rage towards a loved one, and how does one deal with it in therapy? This patient also had a hard time to express any anger towards me. When i ask for feelings towards me he would only show his gratitude for the work I am doing with him. What could I do in such situations? 
You are right. Even in his fantasy he can bring in a defense, another person who holds him back. Fantastic! Another opportunity to show him how he holds himself back in fantasy just like he holds himself back in life. “Notice how you hold yourself back even right now in fantasy? Is this how you also hold yourself back in life? Would you like to break out of this prison of holding yourself back all the time? So if you don’t hold your feelings back in this room right here, how do you experience this anger toward….?”
When you ask for feelings toward you, he says he feels gratitude. Of course, he does. You are probably the best and most accepting listener he has known in his life! So ask him how he experiences his gratitude and positive feelings toward you. As you keep asking him to describe his positive feelings toward you, he will become anxious (sign of unconscious mixed feelings rising).
When his anxiety rises, then say: “Notice how you are becoming anxious? So I wonder, in addition to the gratitude and positive feelings, what OTHER feelings are coming up that are making you anxious? What other feelings are coming up here toward me?”
You see, when you ask about the positive feelings, they are connected to all the other feelings. It’s like when the fisherman pulls up the net, he brings in not only one fish, but all the other fish in the net as well. Why? Because we struggle with mixed feelings: anger and rage toward those whom they also feel love and gratitude.

Why is she becoming more paranoid?

“One of my patients (fragile/depressed/very self-critical) started a new relationship. However, her paranoid ideation increased at the same time. She believes others wish her ill, want to humiliate her, and hope her relationship will fail. She is afraid of being rejected. How does this tally with the increase of projected punitive super-ego? Can unconscious anger be triggered just by getting into a relationship again? Or is she criticizing herself for being afraid? I’m a bit uncertain!” Thanks for a great question!
A new relationship always triggers mixed feelings if our earlier relationships were painful. So the questions for assessment begin. How much trauma did she suffer in the past? How much feelings are mobilized by a new relationship? When these feelings rise, how does the patient deal with them? Can she detach from them (isolation of affect)? Does she turn the anger onto herself and the love toward you (repression)? Or does she project her feelings onto you and other people (projection)?
In this case, the patient experiences mixed feelings toward her new boyfriend. After all, a new love reminds her of the past loves who hurt her. She can split her loving and rageful feelings apart and project the rage onto other people to protect herself as the loving girlfriend and her boyfriend as the all-good boyfriend.
Once the anger is projected onto others, people are viewed as angry: 1) they are angry with me (wish me ill); 2) they want to hurt and humiliate me; 3) they will reject me; and 4) they hope the relationship will end.
Since the patient is also depressed, she either projects anger onto others and fears them (projection), or she turns the rage against herself (repression). Your first task is to help her face mixed feelings inside without projecting them outside. That is known as restructuring the resistance system of projection.
Pt: I’m afraid they wish me ill.
Th: Insofar as you are afraid of how people wish you ill, I wonder what thoughts you might be having about me? [If she projects onto others, she projects onto you too.]
Pt: I wondered if you thought I shouldn’t be in this relationship. [projection]
Th: Is there any evidence for that?
Pt: No. But I wonder about it.
Th: So you are aware of this thought. [cognizing about the projection]
Pt: Yes.
Th: So I wonder what feelings might be coming up here toward me that could be underneath that idea? What feelings are getting stirred up here with me?
Having clarified the projection, ask about feelings. Build the patient’s capacity to bear mixed feelings toward you without projecting those feelings onto you or other people. Building her affect tolerance in this way helps her eventually tolerate 100% of her feelings without projection. This tolerance has to be built initially almost entirely within the therapy relationship. Why? The patient’s projection onto others means that examples in past or current relationships are seen through the lens of projection. Thus, they are nearly always distorted.
With fragile patients we expect that a new relationship will trigger a rise of mixed feelings based on her past. As her feelings rise, they will exceed her integrative capacities, and she will eventually split off and project her feelings onto others. The greater the rise of feelings, the more feelings she has to project onto others. Thus, the more paranoid she will become.
That’s why we focus on feelings in the session to build her capacity to bear them internally without projection. Otherwise, without an internal “storage tank” for her feelings, they will get projected, and she will become increasingly paranoid. And, if we don’t address these feelings with the therapist, her projections in therapy will increase until she acts out and leaves therapy.
Take home point: restructure her projections repeatedly and build her capacity to tolerate ever higher levels of mixed feelings inside her until she no longer needs to project them outside of her.