How do I know if the Patient is Fragile and Projecting his Will or Highly Resistant and Engaging in a Transference Resistance?

If the patient is fragile and projecting his will onto the therapist, his anxiety will be discharged in cognitive/perceptual disruption. His other defenses will be regressive, like splitting, weepiness, and externalization. He will lose some of his reality testing, now beginning to fear the therapist’s will and where the therapist is going to “make” him go in therapy.

If the patient is highly resistant, his use of projection will be a tactical defense, a mechanism to keep the therapist at a distance. The patient’s anxiety will be in the striated muscles and we will see sighing. The patient’s other defenses will be repressive and tactical. Since the patient’s reality testing is good, he does not equate the therapist with the projection. As a result, he is calm and dismissive with the therapist. Whereas the fragile patient is afraid of the therapist upon whom she projects her will, the highly resistant patient is quite comfortable projecting his will onto the therapist. He sits passively while waiting for the therapist to work. The fragile patient who projects is afraid of where the therapist wants to explore. The highly resistant patient looks forward to watching the therapist try to explore.

If you deactivate the fragile patient’s projection of will, his projective anxiety will drop, he will calm down and he will engage in the therapeutic task. If you deactivate the highly resistant patient’s projection of will, he may readily agree with you that it was his will to come to therapy but he will remain uninvolved, passive, and unengaged in the therapeutic task. His anxiety will not drop because he did not have any projective anxiety. His anxiety will not rise because he will remain uninvolved. These responses simply tell you that his problem is not fragility or projection of will but resistance to contact with the therapist. Thus, the therapist can begin to address the resistance to contact with the therapist, “Do you notice how you look away right now?”

When differentiating fragility and projection of the will from transference resistance, assess the pathway of anxiety discharge, the types of defenses used, the patient’s reality testing, and presence or absence of projective anxiety.

 

 

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