“Hi Jon, I wonder what thoughts you have on jealousy. I have had some patients whose close relationships was very impaired by suspicions towards partners. They have a hard time trusting, they envision disloyalty and unfaithfulness, which causes great pain and rage. But what kind of rage? It is rage towards some hypothetical person doing hypothetical things with their partner. It is also rage towards the partner, but again based on something hypothetical. So it seems wrong to ask “what´s your feeling towards her for kissing your boyfriend?” Is this anger best understood as a defensive pseudo-anger, and that the real problem is a pathological superego telling the patient that she is not good enough? If the last is true; how would you go about to establish such a focus? Thanks in advance for any thoughts on this. ”

What about jealousy? What a great question. And he got the key point: the patient is jealous and angry about something that never happened! How do we understand that?

The patient, based on her past relationships, has feelings that arise in a new relationship. Those feelings trigger anxiety in her body. Then here is the key problem: she projects. “He will betray me or is already betraying me with another woman.” When she projects, she now responds not to what her boyfriend did. She responds to what she thinks he did. Thus, her anger and jealousy are in response to an imaginary, not a real, stimulus.

That fact will determine how we work. We never explore feelings toward an imaginary stimulus. We explore feelings only toward real stimuli that actually happened to the patient.

Now, back to our patient and her projection. In response to this projection she becomes angry with her boyfriend for a crime he has not committed. And she becomes jealous of a woman who has not had an affair. In these ways, her projection manages to punish her for being enraged with her boyfriend (the transference feelings related to previous figures).

We do not explore feelings toward a projection (boyfriend who is accused of betraying her but did not do so). That would only reinforce her projection onto the boyfriend. Instead, we have to help her see her projection. In fact, we eventually have to help her see that she is unfaithful to her boyfriend. Rather than relate to him, she is in relationship to another man (her fantasy boyfriend who betrays her).

Two things can help here. Helping her see her projection onto the boyfriend, if possible, is one route. Another is to keep the focus in the room with you. Ask about her feelings toward you. Why? Often, exploring feelings in other relationships is not possible because the patient’s perception of other people is filtered through her projections. As a result, you don’t get an accurate picture of what happened. And let’s not forget, you weren’t there. You can explore projections in a current relationship, but then the patient can respond, “But that’s the way it was! You have to believe me because you weren’t there!” And that’s true. Since you weren’t there, you are in no position to help her see how her projections were not confirmed by reality.

It’s much easier if you focus on her feelings toward you in the room. Then when she projects onto you, you can much more easily address it in the room. You will know what the stimulus was in the room. You will know what her feeling was in the room. And you will know if her projection onto you is accurate. As a result, you will be able to restructure her projection much more easily.

So let’s go back to the triangle of conflict that drives this clinical situation. The patient has mixed feelings (including rage) toward the boyfriend based on past relationships. Those feelings trigger anxiety. To avoid her mixed feelings, she projects onto her boyfriend. The results of the projection (rage toward the imaginary betraying boyfriend and jealousy of the imaginary woman in his life) have the function of punishing the patient. Why? They punish her for her transference-based rage toward the boyfriend.

Now, just one caveat. If the patient’s boyfriend had been unfaithful to her in reality, then we would explore her rage toward him. Why? Because her rage would have been triggered by a real stimulus, not an imaginary one.

Jon Frederickson is the author of Co-Creating Change (May 2013), the first-ever guide to intensive short-term dynamic psychotherapy that includes both an integrative theory of conflict and a moment-by-moment method of assessment to guide therapist interventions. Available for ordering now.

How can we tell if a patient is compliant? First of all, compliance is a defense. The patient is complying with “your” will rather than acting on the basis of her own will and desire. Thus, compliance is something we always try to avoid.

To determine if the patient is merely complying with you rather than exploring a feeling based on her own will, notice her unconscious signaling. If the patient says she wants to look at something, that is an act of increased emotional closeness. That should trigger unconscious anxiety signaled by sighing or slight body tensing. If we see no unconscious signaling when the patient says she wants to explore a feeling, that is a sign the patient is complying. Remember, since compliance is a defense, it will not trigger unconscious anxiety. “I want to” following by unconscious anxiety is an expression of the patient’s will. “I want to” followed by no unconscious signaling is likely an expression of the patient’s compliance—just going along with the therapist.

Interestingly, compliance and defiance are two sides of the same coin: projection of will. If I project my will onto you, I can defy “your” will or I can comply with “your” will. Either way, I will be responding to my projection of will onto you. Thus, the key to deactivating compliance and defiance is deactivating the projection of will onto the therapist.

Signs of compliance include statements such as, “I know you think this is something I should look at.” In response, you might say, “Only you can know if this is something you should look at for your benefit.” Block the patient’s projection and do not explore until the patient declares it is his wish to explore.

Signs of compliance can also include non-verbal tactical defenses.

Th: “Would you like to take a look at this problem?”

Pt: “Sure.” [Said diffidently while sitting slouched in the chair.]

Here the lyrics don’t match the music. The patient says the right word but in the wrong way: diffidently with detachment and uninvolvement. If we listen only to what the patient says but not how he says it, we will end up working with a compliant patient in a stuck therapy. When there is a contrast between what the patient says and how he says it, always pay attention to how he says it. You might respond, “You say ‘sure’, but you don’t sound sure and you don’t look sure. You look and sound detached. Do you notice that?”

Sometimes compliance will manifest in a subtle way.

Th: “What is the problem you would like me to help you with today?”

Pt: “Last time you mentioned the rage toward my sister. Do you think that would be a good place to start?” [Projection of will onto the therapist.]

Th: “I have no idea. Only you can know what would be the best place for us to start today.” [Block the projection onto the therapist.]

Another way to address compliance is to ask about feeling. A highly resistant patient might claim that it is his will to look at a problem but do so in a very detached manner. Since the patient is not yet aware of his defenses, challenging them would be premature. Instead, the therapist can ask, “How do you experience that inside, that you know this is what you want?” After asking several times, the patient will share that he feels nothing inside. Then you can respond, “So we still don’t know if this is what you want to explore. I have no right to explore anything unless it is your will to do so. So I wonder what is the problem you would like me to help you with?” His absence of feeling and activation is the evidence that his will is not online. He is merely complying. Since you are not pursuing his pseudo-will further, his defense has failed, and feeling should rise.

You’ll have a chance to read much more about defiance and compliance and projection of will in my forthcoming book, Co-Creating Change: Effective Dynamic Therapy Techniques.

Jon Frederickson is the author of Co-Creating Change (May 2013), the first-ever guide to intensive short-term dynamic psychotherapy that includes both an integrative theory of conflict and a moment-by-moment method of assessment to guide therapist interventions. Available for ordering now.