As the developer of the Therapeutic Spiral Model(TM), founder of Therapeutic Spiral International and a survivor of violence myself, I would like to talk with you each month about topics of healing and recovery.

My hope is that this monthly column will become a forum that will reach many people who are trauma survivors, their families and the people who treat and care for them. If you like what you read, pass it on. You can send something into the DrKateTSI@mac.com and we will answer your concerns as well.

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Working with Projective Identifications
In Experiential Therapy with PTSD
Lecture Given by
Kate Hudgins, Ph.D., TEP and Maryann (Mimi) Cox, LCSW, PAT
Chinese Guidance and Counseling Association, Taipei, Taiwan, ROC
Leadership Training Group January 2006


What is Normal Projective Identification?

  • Projective identification is a normal process of unconscious communication between two people about emotions. It is a naturally occurring interpersonal process that has its roots in early child-adult interaction.


  • The developmental goal of normal projective identification is that the baby learns how to: 1) identify, 2) modify, and 3) express emotions in a psychologically healthy way in interpersonal relationships.


What does the baby naturally do?

  • As a normal developmental process, babies project their unprocessed feeling states onto the people who take care of them: mothers, fathers, grandparents, siblings, teachers, even animals.


  • They project direct right-brain experience--from their right brain to the right-brain of the care giver. These projected experiences include: 1) intense emotions without labels, 2) fragmented images, 3) body memories with sensations, smells and other sensory-motor information. Both idealized positive and extreme negative emotions and images are projected in an effort to understand what is happening.


  • These projections are an accurate emotional representation of the baby’s internal experience of the external world. They may NOT be an accurate representation of what is really happening in external reality. The baby projects an unprocessed experience—good or bad, happy or sad—onto the caretaker for help in self-soothing over-arousal and understanding the world.


The baby projects right brain experiences to understand the world and feel safe in it.

It is the caretaker’s job to help the child hold these projections and teach the child to self-soothe and interact with others in an adaptive way.

What does the caretaker do?

  • Often, the caretaker is also experiencing a similar emotional reaction as the baby or child. If the child is scared, there may be something that is scaring the mommy as well. However, the child experiences this as life-threatening terror due to its defenseless state. While the mommy might experience it as a mild worry about the loud thunder. It is the caretaker’s job here, to teach the baby to perceive and accurately identify the danger of this situation. In this case, to make soothing sounds to decrease terror, while physically holding the baby safe.


  • The caretaker contains/holds the projection of unprocessed experience/emotion in his or her conscious awareness to understand what the child is feeling. They accurately label it while providing soothing of the amygdala, which is over-stimulated from undifferentiated affect.


The caretaker contains and identifies the projection to teach the baby self-soothing, accurate labeling of feelings, and appropriate expression of them.

 

Why Work with Projective Identifications

in Experiential Psychotherapy with PTDS

Abusive, neglectful, traumatic experiences of overwhelming stress interrupt this normal process of children learning about they feelings from people them in a healthy way. Young bodies do not learn how to accurately label feelings of anger, rage, despair, hopelessness as normal responses to trauma, but instead defend against them with dissociation, denial, and yes, projective identification. This, in turn disrupts the attachment process. When the caretaker is abusive, they learn they should abuse themselves and others when feelings are present. If abandoned, they learn to abandon themselves.

People with PTSD are stuck with unprocessed right-brain experiences of trauma that continue to be unconsciously re-experienced, projected, and acted out. Transferences and projective identification are always unconsciously disrupting the here and now experiencing of a person with PTSD.

Experiential therapy increases access to right-brain information and dissociated affect, which needs to be contained so it will not overwhelm the individual client, the group, or the therapist. Experiential therapy increases the likelihood projective identification will occur, especially in a group of people who have experienced similar traumas.

Learning to work with projective identifications (PIs) provides safety by containing the intensity of the unconscious experiences that are bound to be happening in the group and between therapist and clients with people who have PTSD.

 

Notes on Theory
How to Work with Projective Identification?

In the Therapeutic Spiral Model™

TSM Stage 1:

Create Your Container: Balance thinking and feeling


You can never work directly with PIs without an established relationship of trust between the two people working on them.

This safety structure can be the session contract between a TSM Director and Protagonist, or it can be the long-term commitment to therapy or supervision when working with people with PTSD. Either way, step one is to create a cognitive container and interpersonal agreement between the two people working on the PIs for safety and containment of affect and transference.

The therapist/trainer/team must stay very clear of their own trauma related patterns of countertransference. Accurate labeling of one’s own countertransference and trauma patterns supports accurate labeling of the protagonist’s projective identifications as separate from your own experience..

1) Check your own awareness of Self before any session. Are you in a balanced state of thinking and feeling? Is your body calm? Any thing stirred up for you psychologically or emotionally due to external stressors at work or at home. Any PTSD symptoms triggered or chronic? What is your countertransference to this client?

2) If you are on a TSM Action Trauma Team, you will be asked to check in, identify and own any un-balances in your own internal state. The team shares awareness of each other’s vulnerabilities and takes responsibilities for one own’s doodahs.

3) Establish a therapeutic alliance with your client, protagonist, or supervisee—so you can work on projective identifications when they come up. They WILL happen in any on-going therapeutic or training relationship or setting. Conduct your training, supervision, and therapy as you usually do. Wait for the PIs to show up.

4) Stay aware of supporting your right brain to stay active and bring information to your conscious left-brain awareness. Don’t get caught in problem solving. Listen with all of your senses, not just your mind. Pick up what is unconscious—what isn’t said. What is being projected? Pay attention to your own body sensations, intuition, and feelings and help identify what is yours and what is the clients/trainees.

5) When you experience a client, protagonist, group member, trainee, or supervisee making projective identifications toward you, create a cognitive container and verbal contract to work on the PIs that you are experiencing with that prson. Establish the Observing Ego role internally or externally for client, group members, etc.

6) Build up and develop any Prescriptive Roles that need to be increased for client/supervisee/student and/or trainer/therapist/educator to stay in the here and now. Increase restoration and containment before working directly on PIs.

Now, you are ready to actively work with PIs safely.

When Mimi and Kate started working together on Saturday morning to demonstrate how to work with PIs, they had both already checked in and modified their own mixture of Prescriptive Roles internally and in their relationship. They trusted their friendship and co-trainer relationship without exception in the moment. The container was strong between them.

There was also the extra level of containment from the group during the demonstration. People had been together in group for 2x. Some would continue for another series. Some would end the group that session. Everyone was interested in the intimacy of interpersonal relationships and how to trust someone. This interaction between Kate and Mimi was a good role model at many levels of training for the group. People felt safer and more connected.

 

TSM Stage 2:

Accurate Labeling of Affect and Transference


The second step in working with PIs is to bring the projections into the conscious awareness of the trusting relationship---this is interpersonal communication. TSM Trainers and therapists mirror back what they see/experience as a PI in clinical and training relationships. The protagonist needs to provide insight on the connections to the past they may be projecting. The container must hold the intense affect that will be touched when the disowned parts of the Self are mirrored back accurately from a PI.

1) In most cases, PIs will be an inaccurate picture of the present and more a reflection of unprocessed trauma memories that are breaking through into the present. The right brain is triggered by some unconscious perception from the thalamus and it overstimulates the amygdala, the early warning system in the brain when a PI is happening. An overabundance of stress hormones flood the brain and disrupt cognitive processing of unprocessed affects and transferential images that are disrupting the present.

2) PIs are experienced as a rush of unprocessed, right brain experiences from the past bursting into the present moment. When this happens, the relationship must hold the intensity of the rush of undifferentiated affect. Do not get overwhelmed cognitively. Provide labels about what is happening. Increase the spontaneity of the Prescriptive Roles as needed to help protagonist soothe and modulate affect so that survival defenses do not have to be used again in the present.

3) Help protagonist get curious with you about what is being projected so the mirroring back is not confrontative, but welcomed. If necessary, strengthen the relationship in the moment or over the long term if needed for containment. If the relationship can’t’ hold the intensity of the PI, then you need to go back to strengthen it before doing anymore intrapsychic work on identifying the PI.

Kate reported cognitive disruption of her morning teaching so far with floods of emotion. Mimi helped anchor here into the here and now and her curiosity about what was going on. Normal to feel sad about not being able to attend Mimi’s 50th birthday party, but not equal to the emotional reaction experienced. The cognitive disruption and intensity of affect in the present showed that Kate was re-experiencing something unworked through from the past, rather than accurately responding to the present.

4) Take on the classical psychodrama role of the mirror (Moreno & Moreno, 1969) when you are working to share a PI with your protagonist or group member. You want to not only be the double, the “as if” part of the protagonist, but now you also want to show it back to the protag--with compassion and love so that the accurate seeing of Self is not too disruptive to self-organization.

5) In TSM, you first get a clinical contract to do that mirroring and begin by mirroring back information verbally to increase cognitive functioning of protagonist before you work directly with the unconscious information held in a PI. You can subtly mirror back nonverbal information about body awareness of PIs with your own body as you put labels to the experience..

Mimi and Kate have a long history of being able to mirror back to each other emotional behaviors that are out of awareness but disrupting the here and now. They trust the relationship, the intent of the other, and the accuracy of the information that will be offered. Mimi reaches her hand out prematurely and Kate retreats briefly into humor and intellualization as defenses. She reaches back in quickly with trust and curiosity.

6) Use your own self-awareness of body sensations, your intuition, and your feelings to give feedback to the protagonist on what you are experiencing as you are with this person. Label nonverbal experiences that may be out of the protag’s conscious awareness. Put words to sensations, feelings, thoughts, feelings, and images that are being projected onto you so the protag can IDENTIFY what s/he is experiencing but projecting onto you and into the relationship. Identify to self what patterns of your own are been activated.

7) Do NOT deepen the emotional experience of the PI, but increase the protag’s ability to accurately label the past as it distorts the here and now. Accurate labels help contain the disruptive affect and allows acceptance of reparative experiences.

8) Do NOT deepen the experiencing of any transference that is being projected onto you. Label any transferential relationships you think are attached to the affect that is flooding into awareness. Differentiate yourself from the transference.

Mimi mirrored back some of her nonverbal awareness of sadness and abandonment feelings to Kate. This could have been a clinical hypothesis, observation of behavior in the here and now or de-coding of her own nonverbal experience with Kate. Mimi said she felt the feelings Kate was feeling and Kate had enough cognition to get curious about what was being projected. Mimi held the emotional container while Kate probed the memory of child hood teasing and rejection my middle school children. Mimi says she is not the same as the childhood friends, whom she names, which helps Kate discriminate Mimi as a different person/object from the past.

The container was expanded and Kate was able to experience dissociated feelings of being rejected and humiliated as a child without being triggered into a child ego states. She had enough Prescriptive roles available internally to contain and re-experience this cut off part of self safely, inside the relationship with Mimi.

 

TSM Stage 3:

Adaptive/Chosen Release of Affect and Controlled Regression


Only when the protagonist is able to label the cognitive and interpersonal content of PIs, is it safe for him or her to experience the dissociated affects and ego states that have been cut off from awareness and stored in the right brain. Then, the brain is in a neurobiologically contained state---cognitive processes are active and not overwhelmed by affect. Survival responses are not needed so there is no hormonal release of stress hormones.

Trust in the other allows the container to expand and dissociated affects can be consciously expressed as adaptive feelings rather than just vomiting up rage and hate that does not belong in the present. The TSM Trainer or therapist becomes part of the container and support for expression of affect rather than the object/target of the undifferentiated affect.

Mimi helped create a new self-representation with Kate when the container opened up and Kate could see, feel, experience, and accept an earlier memory of herself as a rejected, abandoned kid who was helpless against the older kids.

1) Create an “Object”—a reciprocal role that can hold the conscious expression of emotion from the protagonist in the here and now. This can be a part of self, a transformed good another mother/father/ancestor, a spiritual role, or the real relationship in the here and now.

2) If you create an externalized role through an empty chair or an auxiliary ego, you can move between director and double role as needed to faciliate conscious expression of emotions in the present that are accurately tied to traumatic experiences of the past. You help maintain the line where emotions are consciously chosen but do not overwhelm the adult ego functioning in the present moment. Express the feelings to the object for containment.

3) If you use the real relationship with the protagonist, you can share your own feelings and personal experiences as they relate to what s/he is experiencing. If you have been triggered during the PI, now is the time to identify that and clear it with the protagonist. You will NOT express the affect to the protagonist, that is for supervision. But you do need to own any PIs that may have been yours during the session. You are the “bigger self”, the “adult ego” that the protagonist needs, the “good enough mother/father” in the here and now and can hold that role for new experiencing.

Mimi offered an interpersonal container in the here and now. It was a true moment of healing when she said that I was her adopted sister in the present. It lifted the shame of the past and let me feel the joy of attachment in the present. Witnessed by a community. WOW! It was a perfect demonstration of working with PIs!!!!!

 

 

 

 

 

 

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