A patient, after exploring feelings, says she feels over-attached to the therapist and is angry with herself for such “stupid” feelings. How should we intervene? If transference feelings are based on projection, do we need to block her projections and work on reality testing or should we focus on the underlying feelings toward the therapist?
Everybody projects. Fragile patients project feelings onto others to avoid the conflict between love and rage internally. Since their projections are accompanied by cognitive/perceptual disruption, and a loss of reality testing, we have to restructure their projections to re-establish reality testing. Then we help them face the feelings inside without projecting them outside onto others.
Patients who use the resistance system of repression may project, imagining the therapist is critical of them. Very quick work to establish reality testing suffices, and then we invite feelings toward the therapist to block the projection and increase the patient’s capacity to bear mixed feelings toward the therapist without resorting to self-attack.
Patients who detach, using the resistance system of isolation of affect, also can project but without a loss of reality testing. Thus, their projections do not usually have to be restructured. Instead, we block those projections, treat them as thoughts, and invite the patient to face the feelings toward the therapist that are underneath those thoughts.
In this case, the patient mentions her erotic feelings, and then resorts to the defense of self-attack. Thus, we would hypothesize that she has both loving and angry feelings toward the therapist. The loving feelings she can admit; the angry feelings she turns upon herself to protect the therapist. This is the strategy for handling mixed feelings in the resistance system of repression.
Pt: “I feel love for you, but it is so stupid of me.” [Self-attack: repression]
Th: “Could this be a critical thought? Could this thought be hurting you? If we look underneath the critical thoughts could we see what feelings are coming up here toward me?” [Identify the defense, clarify its price, and ask for feelings toward the therapist so the rage will be directed outward onto the therapist instead of inward upon the patient.]
Pt: “I told you I love you.” [No sigh, indicating defense.] [Often, the patient shares with you the feelings that don’t arouse anxiety. Always accept them, and then ask for the other feelings that trigger the anxiety.]
Th: “Yes, you have positive feelings here toward me. But if all you felt were positive feelings, we wouldn’t see this anxiety and the critical thoughts. I wonder what other feelings in addition could be making you anxious. What other feelings are coming up here toward me?”
Pt: [Sigh] “Feeling toward you?”
Th: “Yes. What feelings are coming up here toward me, if we look underneath the critical thoughts? What feelings are coming up here toward me?”
Pt: “I feel irritated that I am telling you these things and you don’t tell me what you feel.” [The patient now intellectualizes about her anger rather than turn it upon herself: a small piece of progress.]
Th: “So how do you experience that irritation here toward me?
In this case, the patient is not projecting upon the therapist. As she shares more with him, they become more emotionally close. This triggers mixed feelings toward the therapist. To protect the therapist from her anger, the patient turns the anger upon herself and shows only her love toward him.
The therapist encourages the patient to reveal her mixed feelings. He accepts the positive, loving feelings, and encourages the patient to share the other feelings that trigger her anxiety. As a result, she does not have to hide her rage under her love, sexual feelings, or a sexualized transference.
Through this process, the therapist helps the patient face her mixed feelings of love and rage that come up toward the therapist. Then he helps her face these mixed feelings at progressively higher levels without resorting to self-attack. Once she can face 100% of her feelings without self-attack, the resistance system of repression has been restructured.