Complaining

Projection of the superego. And why I love complainers.

“Does projection of the super-ego always go together with cognitive/perceptual disruption? Is it a kind of tactical defense? Is it a way to avoid facing how I mistreat myself?” Thanks to Peter for these important questions!

Everybody projects. (Welcome to my club: homo projectens!) Thus, projection exists on a continuum from the everyday garden variety projections we all do all the way down to the most primitive projections of psychotic patients.

So we have to differentiate when projections are functioning as tactical or regressive defenses. When projection occurs with anxiety in the striated muscles, the other defenses are repressive, and reality testing is intact, projection functions as a tactical defense, to keep you at a distance.

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

Pt: “You should ask my wife.”

This projection onto his wife is just a tactic to keep you at a distance.

In contrast, when projection functions as a regressive defense, the patient’s anxiety is in cognitive/perceptual disruption, his other defenses are regressive, and the patient’s reality testing is impaired. For instance, if he projects the superego onto you, he looks like he is afraid of you (or, more precisely, afraid of the projection he has placed upon you). His eyes will often dart around frantically, fearing your judgment. Perhaps his legs are jumpy too, wanting to run away from your supposed judgment.

When a patient uses projection of the superego as a tactical defense, block it and continue to ask about feeling toward you.

Th: “There is that barrier again. So what is the feeling here toward me?”

When a patient uses projection as a regressive defense, however, we must restructure the defense, improve the patient’s reality testing, bring anxiety back into the striated muscles, and then we can invite feelings toward the therapist again.

Th: “Is there any evidence that I am criticizing you?”

Very often, therapists try to restructure projection of the superego when the patient’s anxiety is in the striated muscles. This just slows down the process. Always assess: 1) pathway of anxiety discharge; 2) other defenses in operation; and 3) reality testing. Then you will know if the projection is a tactical or regressive defense.

Projection of the superego, indeed, can be a way to avoid facing how I mistreat myself. This is the basis of the defense of externalization. When angry, I hurt myself. But rather than face how I hurt myself, I blame others and claim that they hurt me and cause my symptoms.

Listen very carefully to complainers: they are helping you! I’ll say it again: love your complaining patients. Every complaint they make about another person is an x-ray into their character defenses.

Pt: “He is so insensitive to me. He doesn’t listen to me. He doesn’t respect me. He dismisses my feelings.”

Now for the x-ray into the patient’s character defenses:

1)     She is insensitive to herself.

2)     She doesn’t listen to herself and her feelings.

3)     She doesn’t respect herself and her feelings.

4)     She dismisses herself and her feelings.

Now you now know the defenses that create her presenting problems and symptoms. When you explore examples, you can show her how she doesn’t listen to her feelings in session. You can show her how she disrespects her feelings in session. You can show her how she dismisses herself in session. In this way, you be able to show her how she does to herself what she claims other people do to her.

Take home point: always assess the anxiety pathway, defense structure, and reality testing to differentiate projection as a tactical from a regressive defense. And….love those complaining patients. They are being incredibly collaborative…unconsciously!

Leave a Reply

Your email address will not be published.