“A patient uses massive self-attack. She sees it now and the function and costs. But she is not willing to let go of it. Instead, she follows with a “but” and argues why the self-attack, in her case, is justified and appropriate. Is this just a rationalization I can interrupt and ask for feelings toward me, or is the “but” a sign of ego syntonic defense which needs more work? I thought it was transference resistance, but she is mildly fragile.” Thanks for this question!
First of all, why do patients attack themselves in session? To protect you! This is what you must always remember. If you keep this in mind you will be able to focus on her defense (which you have done very well!) and focus on the feeling toward you, which she has been warding off. I find that therapists often focus so much on the defense, that they forget to go right back to the feeling toward the therapist which is under the self-attack.
Isolation of affect