“When should I explore anger versus restructure externalization? Are these just two poles of a continuum (narrative truth versus historical truth)? I often find myself seeing it neither as black or white but grey. But then, how do I know I’m really exploring a feeling versus reinforcing the patient’s defense of blaming others?
For example, one patient is continuously angry towards her mother for past and present misdeeds. But many times the patient seems to be blaming her mother for her problems or she projects onto her mother, so the mother looks two-dimensional.
When the patient feels her anger, it seems limitless and does not lead to grief or guilt. How can I assess whether I should explore her anger or restructure her defense of externalization? If the mother is being portrayed as more of a part rather than whole object, what do I do?” Thanks for this great and essential question of psychodiagnosis: is it feeling or defense?
When patients feel angry over a wrong done to them in reality, we explore their anger. As we do so, anxiety will rise in the body, and defenses will come up to repress the anger. We will explore the anger, regulate anxiety if necessary, and help the patient see and let go of defenses that prevent the full experience of the anger.
When patients feel anger that is the result of externalization, the anger is not the underlying feeling; it is a defensive affect, the result of the defense. For instance, let’s suppose the patient above reports on some terrible things her mother did to her in the past. As the therapist explores the patient’s anger, her anxiety rises, then she reports on ways she hurts her self. Perhaps she sabotaged herself on the job. Perhaps she screamed at her boyfriend who then left her. So we see that when she feels rage toward her mother, she turns it back onto herself. THEN she does one more thing: she externalizes. “My mother has damaged my life.” Rather than see how her defenses hurt her, she blames her mother. She views her mother, not her defenses, as the cause of her current suffering. Then she rages at her mother, the supposed “cause” of her suffering.
If we explore her rage toward the mother as the supposed “cause” of her difficulties, her rage will be limitless. Why? Because her rage is toward a projection. As long as her projection continues, her rage toward the projection will continue. Thus, when you run into “limitless” rage you are always dealing with a defense of some kind. Sometimes limitless rage is a defense against facing complex feelings. Here, limitless rage is a defense against facing the ways she hurts and tortures herself.
Now, as our questioner asked, how do we know if this rage is the feeling or a defensive affect (the result of a defense)?
Anxiety: feeling triggers anxiety and defensive affect does not because it functions already as a defense.
Defense: feeling triggers a defense and defensive affect does not because it already functions as a defense.
Feeling architecture: has the shape of a wave, rising and then falling after its expression; defensive affect is flat and steady, fluctuating only with the fluctuations of the projection upon which it is based.
Trigger: feeling is triggered by a stimulus in reality, defensive affect is triggered by a stimulus in fantasy such as a projection.
Narrative versus historical truth is another issue. Obviously, the rage that arises is often based on a childhood memory of an early event. As children, when frustrated, we may look at our parents through the spectacles of our rage. And that is what we will remember. Even though this is a “narrative” truth, we can use it in therapy to access the complex underlying emotions to get to the emotional truth.
When the patient is angry with her mother over something wrong done to her, we can explore the anger. However, if the patient hurts herself then blames mother for the ways she damages her own life, then this narrative has a defensive function. “If I can blame my mother with this narrative, I don’t have to face how I have hurt myself.” Thus, we must help the patient see how she, not her mother, is damaging her life today. Once that externalization is undone, we can examine the patient’s rage for what mother really did rather than have the patient retell her limitless rage for what mother didn’t do (but what the patient did to herself: damage her life today).
Take home points: notice if the patient’s anger triggers anxiety and defenses against its expression. If so, this is a feeling. If not, her anger is a defensive affect. If she blames others for her suffering, start looking for ways the patient hurts herself. Once she can let go of her externalization, she will no longer rage at mother for destroying her life (the imaginary stimulus). Then she can face her rage toward her mother for what mother actually did (the stimulus in reality).