Should I restructure projection or ask for feeling?

“I’m sometimes struggling when it comes to differentiating transference resistance from projection. For example, a patient says, “You’re criticizing me,” when the patient knows in reality I’m not. In this example, I’m often torn between exploring the anger coming toward me or do I treat it as a projection and differentiate myself from the projection? When I focus on the anger toward me it often works, but I’ve had a few unsatisfactory experiences when I get iatrogenic anger.
I recently brushed aside the projection and asked what comes up if the patient doesn’t turn my good feelings into something critical. I get breakthroughs of deeply painful feelings when I do this with patients who reject themselves and their feelings. Any thoughts would be helpful.” Thanks to Ange for these great questions!
If the patient thinks you are critical but is able to see this is a perception and not reality, then the projection is a tactic to keep you at a distance, and you can ask for feelings toward you. If the patient is in cognitive/perceptual disruption, the projection will lead to some loss of reality testing, and asking for feelings will not trigger sighing. In such a case, we need to restructure the projection, so the patient can see the difference between you and the projection first before exploring feelings.
In the case Ange describes, the patient has what the psychoanalysts would call a “superego transference.” The patient transfers the superego onto the therapist and cannot see the difference between the therapist and her superego. Exploring the anger toward the therapist would lead to a misalliance since the patient would only become more convinced that you are a critical superego to her.
Ange’s intervention is very effective: “Notice how you take my good feelings and turn them into criticism? Then you would lose me as your ally, and end up alone with a critic. Then you would be lonely here with me, like with your husband.” This would clarify the price of her projection of the superego. She could then elaborate, “Notice how this image of a critic comes in here between you and me? Then you would be in relationship to this critic and then lose all contact with me? And then I couldn’t reach out to you, because I would be unable to reach you from behind this barrier of the critic. Then you would be alone. Why do that to yourself?”
Other variations of this you can find in my book, “Notice how the critical part of your mind takes my caring comments and tries to convert them into a way to punish yourself? Could this be a form of self-punishment? Do I have your permission to interrupt anytime this critical part of your mind tries to come between us to torture you?” “Could you and I join forces against that punitive part of your mind, so it would be cornered instead of you being cornered?”
What Ange touches on here is that projection can show up in different ways in the three systems of resistance: 1) isolation of affect: anxiety in striated muscles, excellent reality testing, projection as a tactic to distance; 2) repression: anxiety in smooth muscles, less reality testing, projection of the superego; 3) projection: anxiety in cognitive/perceptual disruption, projection of a split off feeling of anger usually, loss of reality testing.
In isolation of affect, we can brush aside the projection and ask for feeling. In repression, we must address the projection of the superego to re-establish reality testing and to establish an intrapsychic focus. In cognitive/perceptual disruption, we must restructure the projection to establish reality testing, so the patient can tolerate the emotion of anger inside without projecting it outside. Only then is pressure to feeling advisable.
If the patient is projecting the superego, pressure to feeling will worsen the patient’s reality testing, with the patient experiencing the therapist either as more critical or the patient will become more depressed. If the patient is in cognitive/perceptual disruption, the more feelings invited, the more feelings the patient has to project, and thus, the worse the reality testing and resulting misalliance.
When wondering about what to do with a projection, see what is projected, which resistance system is operating, and which pathway of anxiety is in place. When you invite feelings and signaling stops, pay attention to the defenses to find out which resistance system is operating. That will help guide you on how to proceed.






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