Posted by gardenergirl on July 18, 2005, at 15:11:51
One way to look at why we can sometimes develop intense feelings about issues on admin or other boards is by considering the primitive defense mechanism called projective identification. I admit I often fail to recognize when this is happening right away, but once I do, I am finding it's becoming easier to pick myself up, dust myself off, and find my compassion again.
Please note, projective identification does not always occur between a patient and a treater. It can also occur between individuals who use this defense mechanism and others who interact with the individual.
Here is an excellent essay on the construct of projective identification. I find it confusing somtimes to 'splain. There is a useful diagram of the process on this site, which you can access at http://www.toddlertime.com/borderline/projective.htm#Object
This essay writes about the construct in regards to treaters and patients with borderline personality disorder. It does contain statements which someone might feel contributes to the stigma about BPD, and thus the possible trigger warning above. My purpose in posting this is to highlight the defense mechanism of projective identfication.
The essay, by Kathi Stringer, is below:
"An Object Relations Approach toProjective Identification and the Borderline
Written by Kathi Stringer
See Chart for Reference
The object of this discussion is to clarify and consummate the often confusing material written on the subject of Projective Identification and its concomitants. This model of object relations consists of three components. They are, Projective Identification, Projective Counter Identification and Introjective Identification. The three are interrelated and overlapped. The first two components are executed instantaneously by the unconscious from the interplay of transference / counter-transference.
To describe the dynamic of Projective Identification we must first establish the link between the patient and the treater. Within the patient resides the bad self, good self, good object and bad object. This leads to another process called, "splitting." A patient will split off repressed parts and project them onto the treater and then identify with treater. To be simplistic and to better suit our purposes we will use the paradigm of projecting the bad object from the patient into the treater albeit any object could be projected. The constellation of the bad object consists of the distorted cognition and maladaptive core beliefs of the patient usually caused from child abuse. When projecting the bad object the patient will elicit negative responses from the treater who provided a hook arousing the treater’s counter-transference. One cannot project into a hollow shell. As individuals, we all carry with us the framework consisting of objects, an internal mental structure developed though out life.
When dealing with Borderline patents, countertransference is pervasive and must be continually reassessed in order for treatment to be efficacious. A treater applying an intervention asked a patient if he was aware that he was projecting his anger. The patient respond, "Can you think of anything better to do with it?"
<snip>Once this bad object has been projected and hooked by the treater, the treater then becomes the bad object. This component is known as Counter Projective Identification. The patient can now attempt to control the treater by manipulating the bad object enmeshed within the intrapsychic structure of the treater. As one therapist said, "I know when I am dealing with an abused child when I feel like strangling her myself." When a child is abused, she internalizes and incorporates this badness and will project it impulsively to elicit negative behavioral traits from the treater. This dynamic takes place instantly and unconsciously.
The critical component of this model is Introjective Identification. With counter-transference management, the treater can identify and contain the bad object, modify it, which is then reintorjected by the patient and assimilated. To illustrate this I will use the following example; A resident treating a contemptuous, defensive borderline patient was becoming extremely frustrated with her slanderous remarks. One day he was pushed over the line when she said, "I hope you don’t quite your day job if you go into practice. I mean, look at the way you dress! You will never be able to attract clients!" Withdrawing from this interaction he reflected on this event and noticed that he was becoming just like the abusive patient. When he reproached her, he said, "I am trying to understand what is happening here. When I try and help you, you become abusive. I really want to help, don’t you think we can work on this together?"
This response was unexpected by the patient. In this instance the treater identified and contained the bad object. When he respond with empathy, using coping strategies and aware of his impending countertransference, he modified her internal core beliefs. The treater also created a "holding environment, an empathic extension for the patient. It is important that this holding environment be consistent.
Obstreperous borderline patients are insecure in the world around them. They have concrete dysfunctional beliefs that they are bad, carrying with them the memories of child abuse. This impedes growth since they believe that they can destroy the good object and it will not survive. Incessantly testing limits, hoping for some sense of unmovable boundaries, they are often disappointed by destroying the all good object thereby preventing them from internalizing the goodness of society. All to often their behavior is mirrored back unempathicly reinforcing the empty-self, which substantiates their personal convictions. What they long for is the perfect caregiver who can accept their rage and idealizations and save them from the inadequate mother.
<snip>
It would be unrealistic to believe that an affirmative omnipotent milieu exists. Yet, with structure and a carefully selected treatment plan, using alternate methods to preserve the good object, a borderline patient can assimilate her environment and redefined her beliefs. Nursing personal and treating staff must have a comprehensive knowledge of the fundamentals of mental mechanisms, adaptation styles, coping strategies and therapeutic intervention skills. This improved, goal oriented, therapeutic nurse-patient relationship and an understanding of communication skills, respect, desire to help will facilitate and redefine the borderline’s interpersonal world. As one nurse said, "Kill the borderline’s effect with kindness."Too often the nurse and her contemporaries are ill advised or not sufficiently trained. This will diminished growth and reinforce the patient’s intrinsic pessimistic beliefs. This manifests and invokes undesired behavior extrapolated from their interpersonal contact with the professional staff.
The goal would be to validate the patient’s traumatic past, yet focus on the here-and-now using interpretation as therapeutic tool. Validation is important to advance the alliance with the patient. All to often the treater will insist the this anger belongs to the patient and doesn’t want it crammed down his throat. It would be therapeutically advantageous for the treater to contain the projected anger and hold it, again providing a holding environment.
It is my intent that this paper has illustrated the concept of Projective Identification as a useful instrument to agglomerate in the framework of object relations. Thank you for your interest."
poster:gardenergirl
thread:529665
URL: http://www.dr-bob.org/babble/admin/20050716/msgs/529665.html