Category Archives: Projection

Projection and fragility

When mildly or moderately fragile patients experience a low rise of mixed feelings, they can still intellectualize and exhibit tiny sighs. However, as those mixed feelings rise, they are no longer able to bear the rising feelings. In response, sighing stops and anxiety shifts into cognitive perceptual disruption. To stop the worst of those symptoms, patients split feelings off from themselves and project them onto others.

They no longer fear their feelings; they fear the people onto whom they have projected their feelings. They no longer relate to people; they interact with the projects placed upon those people. They are no longer anxious due to internal feelings; they are afraid of those feelings they perceive in other people.

Projection of anger

“You look angry.”

“You wanted to kick me out of therapy.”

Projection of will/desire/love

“I’m afraid of the questions you want to ask.”

“I feel like you are trying to get into my head.”

Projection of disowned parts of self

“You think I’m psychotic and want to put me in a hospital.”

Notice that projection involves qualities, feelings, or wishes of oneself. This is different from transference.

Transference

Transference involves projection, not of a part of himself, but of an image of another person.

“My boss treats me like an incompetent boy.”

Here, the patient projects, not a feeling or desire within himself, but an image of a person, his father, onto his boss. This is transference, not the kind of projection we see in fragility.

Why do ISTDP teachers say different things about projection?

“In your book you have said we don’t ask for feelings if someone is projecting onto us. But in Allan Abbass’s new book and one of Patricia’s videos people ask for feelings when the patient is projecting onto the therapist. This is confusing. Does the difference lie in whether the patient’s anxiety is in striated or not? What if the patient isn’t showing any anxiety?” Thanks to Albert for this very important question!

First of all, everybody projects, even you and me! Projection can range from the psychotic man who claims that space aliens are communicating to him through the fillings in his teeth to the daily blatherings of politicians onto each other. So, to deal with projections, we must understand where the patient is on the spectrum of resistance.

As you know from earlier blogs, in ISTDP we see patients handling their mixed feelings through three strategies: 1) projection: I split off my feelings and project them onto other people; 2) repression: I split apart my feelings and turn the love onto you and the rage onto me; and 3) isolation of affect: I detach from you to detach from my feelings.

Patients who use projection as their primary form of resistance suffer from cognitive/perceptual disruption, losing a sense of reality testing when they project. As a result, they become afraid of you, since they equate you with the projection. This is known as symbolic equation: equating you (reality) with the projection (symbol). Thus, the first task is to differentiate you from the projection and re-establish reality testing. As soon as reality testing is established, then we ask for the feelings toward the therapist. Why? We must build the patient’s capacity to identify and bear mixed feelings toward the therapist at higher levels without projection to restructure his system of resistance and pathway of anxiety discharge.

Patients who use projection in the system of resistance project that you will be critical of them and they become depressed in response to this projection. Again, you help them see the difference between you and the projection. Then you ask for the feelings toward you, so they can bear their mixed feelings internally without attacking themselves. These patient’s projections restructure very quickly because there is not a marked loss of reality testing. In fact, most of the time, if we simply ask patients who repress about the feelings toward us, providing an outward pathway for the feelings, the weepiness will decrease, sighing will increase, and the patient’s depression will diminish in the following minutes.

Patients who use projection in the resistance system of isolation of affect suffer no loss of reality testing, their anxiety remains in the striated muscles, and their other defenses serve isolation of affect. In this case, projection serves as a tactical defense, a tactic to diversify away from your focus on the feelings toward you. Projection in this case requires no restructuring at all.

To compare these kinds of projection according to systems of resistance, let’s review their differences:

 

Projection

Defenses:  Splitting, projection

Result:  scared of therapist

Anxiety: c/p disruption

Reality testing:  impaired

Intervention: restructure projection until sighing, tension, or intellectualization returns, then invite feelings INSIDE the patient

 

Repression

Defenses:  Self-attack, weepiness, tiredness, somatization, conversion

Result: depressed

Anxiety:  smooth

Reality testing:  easily corrected

Intervention:  Identify defense, invite feelings TOWARD the therapist

 

Isolation of Affect

Defenses:  Intellectualization, rationalization, detaching

Result:  detached

Reality testing:  no problem

Intervention:  ignore the defense, invite feelings toward the therapist

 

 

In my book, due to limitations of space, I focused on how to address projections when patients are fragile, using the resistance system of projection. Allan’s book shows how to use pressure to feelings once the fragile patient sighs again, and how to use pressure when the highly resistant patient uses projection as a tactical defense. Patricia’s video also shows how to press for feelings when a highly resistant patient uses projection as a tactical defense. In future blogs, I’ll take you through this spectrum of projection, showing how we intervene differently and how we invite feelings differently to block systems of resistance while mobilizing complex mixed feelings.