Object Relations Therapy
1. At the heart of object relations therapy is working with PROJECTIVE IDENTIFICATION.
2. The Object Relations Therapist is required to use the therapeutic relationship to allow
the relational pathology (Projective Identification) to emerge. Build a working alliance.
3. The therapist recognizes the Projective Identification through the patients Meta
Communication (lodged in the Projective Identification).
4. The therapist first receives the Projective Identification, uses his counter transference
(therapist conscious knowing and motive based presence) to process the projection by
inviting, receiving then giving it back to the patient to eventually re-internalize it and
end the split.
5. This is done by first receiving and then appropriately contradicting the Projective
Identification at an appropriate time- so that over time the patient gains an insight into
the nature of their CURRENT OBJECT RELATIONS and eventually the nature of the
internal splits they project onto the therapist.
6. The patient - therapist relationship undergoes concrete alterations as the therapist first
receives then reflects/deflects the Project.
7. So, it is the therapist’s response to the Projective Identification (unlike other people in
the patient’s life who act with anger, frustration, depression or abandonment) the
therapist stays with the patients whilst he projects. The therapist receives the P.
Identification who when projected onto.
8. USE OF THE THERAPIST/PATIENT RELATIONSHIP
In the here and now therapist responds to the patients ongoing manipulations, by at the
right time, actively receiving, then engaging with and then by confronting and then
refusing to the Projective Identification. The therapist uses the relationship to alter the
habitual, self defeating ways the patient relates to others (by Projective Identification
with others).
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9. The therapeutic intervention is contained in a 4 stage process:
a.
i. By inviting and eliciting the Projective Identification by emotionally
engaging the patient (acting the induced feeling).
ii. By the counter transference that confirms the Meta Communication.
Identify the exact Projective Identification. When I am mindful – I will
identify the Projective Identification through my counter-transference.
b. Confronting it (see the method below).
c. Reconstituting the relationship in which it occurs.
d. Termination of therapy- a) feedback b) interpretation and c) letting go (after the
client has resolved the split).
4 Stage Process
1. Engaging the Patient:
a. The patient comes into therapy mainly due to frustrating, un-gratifying
relationships (failed external object relations) with significant others.
b. They feel Anxiety, depression, feeling overwhelmed with life (internal conflicts
from unmanageable existing splits).
c. The Engagement phase of object relations therapy is meant to deal with the
discomfort, incongruence and conflict through a working alliance (that initially
consists of caring, commitment and involvement. This requires unconditional
presence- building the bond of trust and fulfilling some of the clients’ objects
relations, needs through Projective Identification (that is felt and received) by
acting out the induced feeling.
d. If the bond does not form- (too much interpretation or advice too early) can
cause the patient to terminate early (do not induce the patient too early by
inducing Projective Identification till the working alliance has formed).
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2. By Emotional Linking: (to create a therapeutic bond)
a. Techniques that convey empathetic understanding.
b. Rooted in Rogerian approach. Highlight the emotional message in what the client
says.
c. Raise and voice the feelings the client has not expressed.
i. I don’t like violent movies. (client)
It seems like physical violence makes you anxious. (therapist)
ii. I have to be so careful of what I say at work. (client)
It must be depressing not to be able to trust people at work. (therapist)
d. This changes narrative and factual dialogue to one that is emotional in character
and creates and strengthens bond.
e. The therapist needs to pick up mal adaptive or self defeating patterns (deficient
object relations in failed relationships, in failed romances)- by staying with the
client do not interpret or advise.
f. Empathetic Reflection in couples therapy (for example) align yourself with 2
truths the husband truth and wife’s truth, give both spouses something that
makes them bond with you as a therapist.
g. Using Humour (see Isabel pg 90 and Mare pg 92)
h. Suggestions and Advice Only if it is safe - innocuous and has a good chance to
succeed.
It should not solve problems but engage the patient. Engagement can also arise
from offering suggestions and advice. (See Eduardo and Victor p 94) which is of a
functional nature (non psychological).
i. The engagement phase of Object Relations Therapy is intended to create an
ultimate relational foundation that therapeutically bounds the patient to the
therapist.
Purpose of engagement- That the therapist is able to enter into the patients
inner object world. (He/she is feeling better, the client-therapist interactions
have improved, life is less bleak). A working alliance is forming.
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Working with Projective Identification
1. If the therapeutic bond is strong then the patients Projective Identification will start to
surface faster.
2. Object relations therapy differs from other therapies in that the therapist is not just
listening and identifying Projective Identification, instead he/she becomes the target of
one. The therapist becomes personally drawn into the patient pathology.
3. How the Therapist Identifies that he is a Target of Projective Identification
Vague feelings in the therapist (during therapy) that he is the target of Projective
Identification is feelings of irritation and anger, self doubt, sexual arousal (all these are
Projective Identification induced counter transferences in the therapist).
4. Is the counter transference induced by the Projective Identification or is it arising from
the therapists own inner state (therapist needs to check this).
Catching, Identifying and working with 4
Projective Identifications
Dependency – I am helpless - you help me or I may perish
1. Patient put therapist into the role of caretaker.
2. Patient makes the therapist feel omnipotent, all knowing and exceedingly incharge.
3. Patient is constantly idealizing and looking helpless dependant- advice, direction and
support seeking.
4. Patient relates to therapist as if he has all the answers. The therapist seemingly for the
patient knows things the patients does not.
5. The only way the patient thinks he is valued is by behaving helpless and inducing help
from the therapist by expressing helplessness.
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6. By professing neediness or acting incapable of managing their lives they feel the
therapist will stand by them and not leave them or invalidate them. (See Catherine p
99).
7. Clients make emergency calls (all to force the therapist to handle recurrent (out of
proportion) created false crises putting the therapist into the position of savior.
8. Behind the request for guidance cries for help- LIES THE ACTUAL META
COMMUNICATION.
9. How does the Meta Communication manifest itself- how does the therapist recognize
the META COMMUNICATION.
10. This is made apparent by the therapist s counter transferential response an urge to help
the patients (beyond what is considered appropriate) (longer sessions - more sessions
per week, personal phone calls.)
11. The manifest Communication is visible in the therapist as client’s excessive helplessness
inducing counter-transference feelings of over protectiveness, over helpfulness, care
taking, giving unsolicited or unrequested advice.
12. Because it is unwittingly given advice (the patient asked for) it invariably fails to
accomplish what it is meant to do- the patient starts blaming the therapist. (see p 101-
Woman with over controlling)
HANDLING DEPENDANCY
13. The therapist when forced with the Meta Communication to help (I cannot survive
without you) must exercise self restraint stop the initial impulse to save or care take and
SELF EXAMINE the induced counter transference – recognize the Meta Communication.
(See p101- Readers Digest Sex Tips).
14. Therapist acts with Restraint
Correct use of the counter transference means becoming aware not reacting to ones’
one induced reaction. This means,
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a. Allowing one self to consciously recognize and emotionally respond to the Meta
Communication embedded in the projector identification. I cannot survive
without you.
b. Using this Meta Communication (information) (I cannot survive without you) to
identify the Projective Identification. In this case DEPENDENCY initially receiving
it as an emotional barometer. By being consciously, emotionally responsive to
what is going on within himself (as Therapist) – how do I feel with the constant
client need for me.
c. By consciously responding to i.e. help me, or I will die by initially obliging the
Meta Communication, the therapist gauges the nature extent compulsivity depth
obsessiveness of the Meta Communication and thus of the Projective
Identification.
DEPENDENCY THERAPY
15. Once the therapist has
a. Held back
b. Assessed the exact nature of Meta Communication
c. It is time to finally consider the appropriate therapist. Response when Meta
Communication dependency has established response.
d. After initially appearing helpful providing advice, giving direction and offering
guidance – (this reinforces the patients’ pathology) to assess the Meta
Communication only.
e. It enables the Meta Communication to COME INTO THE OPEN so it can be
handled directly.
16.
a. The private hidden Communications and Meta Communication (I cannot survive
without you) has to be translated into more specific Communication that are
open and clearer (to work with).
b. So I cannot survive without you or I cannot function without you has to be made
more explicit. (otherwise the therapy will bog down in innuendos.
17. How is the Meta Communication forced out into the OPEN? By doing the following.
a. Highlight the interactional nature of what is taking place (what you said- how I
responded) you kept wanting my help what did I keep doing? Suppose I don’t do
that anymore.
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b. Therapist brings the actual relationship into the room by legitimatizing and
concretizing the actual ongoing dialogue in the here and now. So, the client
actually becomes aware and less unconscious Induction, Communication and
Meta Communication is misused when it is verbalized and confirmed in the here
and now (by the therapist). He challenges in the room – in the moment.
18. Patients invariably find it easier to talk about the patients’ relationships with others-
parents, spouses.
19. The Therapist can fall into this trap of talking around the patient- the therapist’s here
and now relationship (as a defense against what is going on in the room). (see p 102
School teacher with OCD).
20. The therapist must bring the hidden or unconscious interaction into the room)
exp: Therapist brings losing control sobbing uncontrollably by the client in to the room –
the communication are made as explicit and as direct as possible.
21. If the dependency (P.I) patient is vague with induced Projective Identification asking
‘What if I asked you to help me with this?’ ‘What if I asked you to teach me how to….’
22. The therapist must
a. Concretize by asking the patient- ‘You will have to ask me to find out’, wont you.
Or ‘There is only one way to know.’ – make the innuendo explicit with the
patient.
b. So by forcing both Communication Meta Communication into the open by
making it a visible palpable part of the dialogue in the here and now in the
ongoing relationship (the actual P.I) is forced into the open. The client sees for
himself what he is inducing and examines this with the therapist. What happens
when you constantly seek my help. What if I don’t give it.
c. Now the therapist has created some awareness for the client of his/her habitual
mode.
d. Now comes the difficult part- saying NO to the clients’ dependency demands by
refusing to offer further sympathy, guidance and support, the patient obsessively
asks for.
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e. Here the therapist must be fully in charge of the counter transference that says-
‘Be a helping professional’ the client acts out even more at the therapist’s refusal
to be helpful (as his spilt returns).
f. Refusing to comply is made more difficult by the patients regression into I will
not survive- I will not live (embedded in the Meta Communication) the split is
revived (in the patient) who now is anxious, clingy, angry (despite some
awareness of their Projective Identification becoming a split as it is refused.
g. However further compliance with the patient’s demands for help will feed into
the patients pathology create more dependency so let the Meta Communication
surface.
23. The final goal at this stage is to make the patient fully realize that his soul interaction
was- I cannot survive without you my therapist.
24. So, now the P.I (Meta Communication) is made to fully surface it is no longer the
patients projective fantasy.
25. Now the dependency pleas for help threats of not surviving are all a tangible feature of
the manifest here and now therapist- patient relationship, it is completely out in the
open.
26. It is incumbent for the therapist now to refuse to oblige- is to say no to the patient then
confront him/her appropriately.
27. More and more painful awareness will arise from refusal and challenge (the client’s split
may make him temporary or permanently go – this is a risk that has to be taken).
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POWER
1. Here the patients’ pathology manifests through issues of control.
2. Main question for the patient/therapist encounter is who is in charge the patient is
desperate to control the sessions!
3. So the therapist is supposed to be the expert but the patient assumes the stance of
directing everything.
4. The patient treats the therapist as an extension of his other relationships with significant
figures- domineering, controlling, overly critical.
5. Close relationships are structured hierarchically. All are based on who is on top, then
next and who is at the bottom (all in terms of the patients’ domination).
6. Regardless of love or work relationships the patient has to be in control (to do this he
tries Meta Communication to induce feelings of helplessness professional impotence in
the therapist).
7. Whilst the dependency P.I patient felt deficient therefore was constantly help seeking,
the opposite happens here- others are deficient dysfunctional without me to lead them-
so in psychotherapy (as in the world) the patient must dictate the treatment and
everything in it.
8. Projective Identification Power in Therapy
See Nancy p.104 controlling the time to meet for a session, controlling and dictating
who controls scheduling, who controls the entire therapeutic relationship.
9. I will do it my way (Paul Sinatra) exemplifies this
Stage 1 Allowing the client to control the therapists’ induced counter transference
(feeling of ineptitude) tolerate even encourage the Meta Communication ‘You cannot
do or survive without me’. So the client is in a way hooked.
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10. Stage 2 Bringing the therapy into the room in P.I Power.
Shift from patients discussions, about interactions with others to patients’ interaction
with the therapist. Bringing the communication between client and therapist into the
room.
Question in Stage 2
“Do the feelings of anger you feel towards your boss also arise with me (sometimes)?”
11. Stage 3 Making the client aware of the control and power play (makes them angry).
Therapist says ‘I see you always want me to follow your advice regarding what and how
we do therapy.’
The Client will react with anger, deny or reject outright, client regard as foolish or off
base client tries to shift the DISCOURSE.
The Therapist must not be dissuaded in fact what is achieved is bringing the therapist/
patient interaction into the room so the communication/meta communication is
confronted.
The discussion finally moves into what is going on in therapy (rather than endless talk
about relationships outside the therapy or in the past with others.
12. Shifting the focus of the therapy from discussions of power and control in the client’s
interactions with others to such interactions with the therapist.
13. To do this Therapist asks- Are you feeling just now about me, similar to how you feel
about other key people. Talk about what is going on in the therapy in the Now.
14. The therapy now needs to be rooted in the here and now of the therapist/ patient
interaction. (not past relational experiences)
Exp- p 106.
Patient- I wonder what would happen if I asked the questions.
Therapist- I think I hear you wanting to take charge.
Patient- You distort and misinterpret everything I say, I really think you are quite new
and inept at all this.
15. The most common counter transference response in the Therapist to a Projective
Identification of power are feeling of emasculation and inadequacy – (self) doubt- ‘Am I
actually missing the point or mismanaging the therapy??
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16. The therapist needs to analyze his own counter transference- recognize his reaction to
the Projective Identification.
17. When the patient is in full flow controlling the session in a diatribe,
The Therapist switches places by saying - You want to do a better job here it’s all
yours, go ahead.
The Patient will be confused silent and maybe give in. This is a beginning.
18. The Meta Communication message embedded be added in cases of P.I Power is you
cannot succeed or survive without me. The counter transference induced in
incompetence and failure
a desire to get rid of the patient.
19. The resultant induced counter transference felt by the therapist is in competence,
inadequacy and failure (as the therapist is berated for incompetence and impending
failure (and for failure to produce major charges) with impatience for not being in
charge (as things would move for better with me handling them). A desire to get rid
themselves of the patients are all induced counter transference from P.I power patient’s
manipulative maneuvers.
20. The patient comes up with crises and emergencies that the therapist never can handle
(as per the patient). Competently, the patient is chronically dissatisfied. Now the
Therapist really wishes to rid himself of the patient.
21. The therapist needs to use the P.I counter transference as a relational window into the
patients’ interpersonal pathology.
22. The need is to highlight the P.I power and expose the Meta Communication (putting
aside their own feeling of emasculation, ineptitude, helplessness, self doubt.
23. The Meta Communication message embedded in cases of Projective Identification
POWER is- you cannot succeed without ME!
24. The therapist must become aware of his induced feelings (the counter transference is a
relational window into the patients’ pathology) the counter transference actually
provides the diagnosis. What meta communication is the patient throwing at me.
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25. Upon recognizing this Therapist USES the counter transference to respond to the
patient therapeutically (rather than reactively or angrily which is like being angry at a
patient who is ill).
26. Business Executives and Psychotherapists tend to use P.I power and control the
relationship by dominating and controlling the relationships primarily through
intellectualization, a kind of one upmanship!
The Therapist Needs To
a. Bring the therapist/ patient interaction into the room.
b. Highlight the operation of the Projective Identification (power)by exposing the
Meta Communication (you cannot do anything without me- in fact you cannot
survive as a therapist without me)!
c. Expose the clients’ constant refrain ‘whatever you do in the therapy will fail
without me.’
d. Let the client reduce the Meta Communication into here and now words direct
one to one Communication (in the here and now) that actually says this in
words. So you feel I am useless – I cannot be a therapist without you. What if I
can? Here the second phase of treatment stands realized).
Sexuality
1. In P.I sexuality, sexual behavior from the client starts becoming a salient part of the
client therapist relationship.
2. So much so that a therapist when faced with the Meta Communication- I’ll make you
sexual- I’ll arouse you.’ Tends to take the sex out of the room to avoid its mention or
very presence, to make it less threatening-
E.g:- Did you have same feelings with others in the past. Let’s see other aspects other
than sex.
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3. What is essential (yet difficult) for the therapist is to keep the sexual content in the
room between them and not redeposit it in the patients past or ongoing other sexual
relationships (rather than making it palpable in the therapist-client encounter).
4. This is a fundamental mistake- it is avoidance of the Projective Identification that is to be
avoided. The therapist needs to create an in vivo relational enactment (in the here and
now) of the patients’ projective fantasies, by becoming the target or recipient of the
sexual Projective Identification (separating his historic counter-transference from that
induced by the client).
5. Initially it may be the only way to keep the client in the room (so the therapist must
neither suppress nor avoid expressions of sexuality) regardless of ethical dilemmas. The
Therapist needs to stay in control of both his counter-transference and the client’s
erotic transference.
6. The patients’ Meta Communication is acted out by him/her by introducing erotic
elements into the relationship.
7. Example:
a. Detailed accounts of their sexual lives.
b. Women talk about types of orgasms (surface or deep).
c. Men about sexual conquests with details about the sex that followed.
d. Double entendres.
e. Types of sex (sexual words/codes) e.g, jelly beans, female ejaculation.
f. Sexualization via
i. Erotic clothing
ii. Body parts are exhibited
Legs, Breasts, Cleavage. Men- Legs akimbo- to say this is the most
significant part of my body, this is who I am.
g. The patients present what they perceive as the most important part of
themselves which the therapist will ‘value most’. (see p 110)
h. The patient in a sexual Projective Identification is convinced that other people
(include) the therapist stay in relationships only if they can arouse or satisfy
them sexually or make the recipient feel more manly or more sexually feminine.
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8. The patient is convinced that the therapist will stay in the therapy because of sex. So the
bottom line is providing erotic fulfillment and the self confirmation of their sense of self
by the patient is through the therapists’ arousal.
9. ‘The only place I am anyone is in bed.’
‘The only value I have for others is the sexual satisfaction I give !
This is a disheartening commentary on Human existence.
10. Identifying Sexual Projective Identification
Again see the counter transference in the therapist’s feelings of sexual arousal (counter-
transference). Titillation- sexual stimulation is felt by the therapist. If the patients’
induction works, the induced counter transference is Sexual Excitement.
Exp Sean (p 111), and Beata (p111-112)
11. The therapist can misinterpret the induced counter transference as misplaced, unethical
feeling, stuck unprofessional and incompetent. (The actual fact Judy therapist p 112)
was that she could not come to terms with her aroused sexual feelings. It is seen as a
mark of professional failure and not as natural counter transference arising from the P.I.
12. A good therapist will recognize the induced arousal (not deny or suppress it).
13. The failure if any would be the failure to recognize the counter transference or by fully
acting on the counter transference by being sexually involved with the patient (thereby
confirming the patients’ worst fears- I am undesirable and tolerated only for the sexual
pleasure I provide. I am only am, if I am sexual).
14. Therapists Main Task
To bring the Meta Communication out by identifying the induced counter transference.
Bringing the Seduction (the Meta Communication) out into the open. Can we actually
look at what you are saying and doing.
15. The therapist may find it difficult because when confronted the client may say- my
alluring clothes is what therapy is all about. Or, you are a voyeur or you just have sex on
your mind. Causing the therapist to back off which is a fundamental mistake. (playing
safe).
16. OBJECT RELATIONS - the Guiding Principle
Sink or swim with the counter transference.
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17. Sometimes the Meta Communication is explicit, on the surface and emerges without
much instigation sometime it is subtle hidden, denied needs to be fully examined to be
conferral.
18. The therapist needs to be fully AWARE of his counter transference of arousal and on
believing that the counter transference was precipitated by the patient. (Regardless of
feelings of personal embarrassment or diffidence or ethical/ moral confusion, the
therapist must persevere- ie- to identify the underlying patients’ message behind the
Meta Communication (get aroused).
19. The Meta Communication (get seduced or aroused) must be made an explicit part of the
here and now relationships.
20. The therapist must therefore bring the met a Communication out into the open. (see
Beata p 113).
21. Forcing full blown expression of the Projective Identification sexuality into the open may
seem cruel and unfeeling, however what is really cruel is leaving the patient to suffer
the frustration and emptiness of sexuality (as the only way I can be accepted).
22. The Therapist must accept that his counter transference is not imaginary – the
Projective Identification is a palpable point of the patients object relations and an
integral part of the psychotherapeutic relationship.
23. The 2nd stage of object relations therapy is therefore to bring the Meta Communication
(behind object relations sexuality) – out in the here and now moment. So the client is
made fully aware of their sense of self, emanating from just being sexual.
Ingratiation
1. In this Projective Identification of ingratiation – the main displayed emotion and
behavior by the client to the therapist is SELF SACRIFICE.
2. The patients’ message to the Therapist is:
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a. See how much I put myself out, keeping notes of each session out for you.
b. See how much I give of myself to you. I am your most interesting /intriguing
patient.
c. I feel so unappreciated in this therapy.
d. Offering to be therapeutic guinea pigs (be the objects for any experiment).
3. What will not suffice from the therapist is a thank you. The patients’ Meta
Communication is you owe me – so a sense of guilt is produced in the therapist which is
far more than appreciation and routine acknowledgment by the therapist!
4. How the patient expresses Projective Identification – Ingratiation.
a. Patient initially being helpful and over accommodating: Advising on office decor,
acting as interior decorator. Bringing paintings or decorative items like rugs as
presents. (see Daniela p 119)
b. Telling others how capable the therapist is, trumpeting the therapist capabilities.
c. Bringing friends to therapy, trying to increase therapists business.
5. Making it impossible for the therapist not to appreciate the client. (see Norman p 115).
6. Exp: Dr Cashdan is on time– Why can’t we all also be on time (in group therapy).
Ashtrays/ water/ seating arranged, cleaning up at the end.
7. At times the therapist fails to recognize what is going on and is drawn into the pathology
of the relationship unwittingly.
8. It is essential for the therapist to let the patient persist so that the precise extent/
nature and character of the P.I – may be fully identified.
9. The therapists counter transference response to all the patients’ Meta Communication –
“see how much I do for you, you really owe me” – is the therapist appreciation feeling
touched and moved, feeling beholden by all the sacrifice and indulgence (from the
client).
10. The Therapist may feel guilt at not being appreciate enough (unconscious induced
counter transference).
11. The therapist must force the META COMMUNICATION into the open – ask the patient
what the over solicitness is to obtain from me? The counter transference is consciously
used. ‘What will my appreciation do for you? Patient may admit to “I just want to be
useful”.
12. Here when the Meta Communication is “you owe me” – do not acknowledge the
appreciation (in this room – in the here and now). Appreciation and acknowledgement
is withheld and the patients’ response examined through feedback.
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13. The counter transference is positively used to expose the Meta Communication.
Ingratiation
1. Structuring relationships so that the major emotional component demonstrated is that
the self sacrifice. (Always show the recipient how much I do for you).
2. The recipient is constantly made away that the projector is giving up something or
putting the recipients’ interest before their own.
3. The induced feelings are gratefulness for the self sacrifice of the projector.
4. Statements or Communications of the projector;
a. I try so hard to make things easy for you.
b. I work my finger to the bone,
c. You don’t appreciate how much I do for you.
d. You always take me for granted.
5. Both the projector depicting what they do (I work so hard) or what the recipient does
( you have done enough) is to elect appreciation- seen to be helpful.
6. Feeling Induced
So the feeling to be induced is thankful appreciative;
a. I am only loved if I am helpful.
7. Parental Message
Do things for me to be loved- Always sacrifice for me.
8. Split
You are only good if you are constantly useful to others, constant help giving usefulness
only to induce gratitude indebtedness.
Bad-
Projected to show self sacrifice only to induce gratitude.
Good-
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I do not need to do things to ingratiate to be wanted or to be loved. I am ok.
My intrude worth does not arise from utilization deeds – I am ok.
Projective Related Stance Meta Communication Induced Feeling
Identification
Ingratiation Help self sacrifice You owe me Appreciative
gratitude
General Steps for the Therapist
Stage 1
1. The Meta Communication is responded to by the therapist first creating a relationship.
2. Engaging the patient using emotional linkage Non-Therapeutic advice and humor.
3. Creating a bond that makes the therapist feel close enough to undertake Projective
Identification.
4. The clear expression of the Meta Communication must be sought so the Projective
Identification is clear.
5. The Meta Communication must never stay vague or ambiguous (it is fully noted through
the therapist’s counter-transference).
6. So ideally the Meta Communication will enter the room in the Here and Now, in the
form of patients statements like - I cannot survive without you or your help or I want to
sexually gratify you.
7. Although bringing Meta Communication starkly worded into the room seems adversarial
and cruel – It arises from eventual concern for the patients’ well being (to bring his
psychopathology to his awareness).
8. At times guilt, confusion, double mindedness lack of clarity (at the exact nature of the
Meta Communication and therefore the Projective Identification) plague the therapist.
9. When the Meta Communication is exposed, the patient slowly realizes that their P.I is
self defeating, unproductive, emotionally draining. They disrupt lives and cause
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unending pain to themselves and others.
STAGE 2
10. The exposure of the Meta Communication in the relational immediacy of the
therapeutic here and now encounter, will create relational clarity – for better or for
worse – the cards are on the table.
STAGE 3 - CONFRONTATION
11. Here,
a. The therapist has recognized the Meta Communication.
b. He refuses to concede or conform to the Meta Communication demand.
c. The correct therapeutic response is a clear NO.
d. So by confronting the patients’ habitual mode of confronting relationships by
manipulation and inducing an ejected part of themselves – the therapist
challenges (to end) the Projective Identification.
e. Many challenges will occur during this phase – the client will act out as the split
goes back, into the client. Client may disappear, feel suicidal threaten. The
therapist must stay unrelentingly appropriate.
STAGE 4 - FEEDBACK AND TERMINATION
12.
a. Once the client (albeit very slowly) comes to terms with his behavior
(communication – Meta communication – split) through feedback to the client
and responses from him – the client will slowly start the process of gradual
withdrawal from regular therapy.
b. The termination must ensure that the patient is fully aware of a) his previous
inner split, b) of efforts by him to rid the split through Projective Identification c)
of the agitation and frustration that arises when others do not get included by
his Meta communication.
Termination requires proper feedback from the client so that the therapist
confirms all of the above.
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