Distinguishing between externalization, projection and transference

Understanding the nature of the patient's defenses is crucial for accurate diagnosis and for constructing effective interventions. The term "projection" is often overused and mistaken for externalization or transference. Making these distinctions will increase your ability to make an accurate diagnostic assessment and intervene effectively.

[@ejinchina4630]

I wish other experts spoke so directly without so much psychobabble... I’ve watched every video like three times because no one else explains these topics like you

[@patriciacoughlinphd1852]

So glad you find them helpful. A good rule of thumb, when you are trying to learn something, is to explain it to a 12 year old. If you can explain it simply, then you know you understand it!

[@PoppySprague]

Absolutely brilliant! Thank you Patricia, this is so helpful to break it down this way.

[@annasokolova6923]

Happy you are back, Particia! Have a wonderful year and thank you for another meaningful and deep video!

[@patriciacoughlinphd1852]

My pleasure

[@happygucci5094]

You explain things with incredible clarity and depth. New sub.

[@patriciacoughlinphd1852]

So glad it's helpful.

[@stevenealon6007]

Great to have found your channel. Thank you for the very helpful videos.

[@toslso]

Thanks so much, very insightful

[@jillbishop3826]

Appreciate the note that there may be more restructuring needed, even if we get the green light. Looking forward to your training in Feb with istdp San Diego!

[@patriciacoughlinphd1852]

We need lots of green lights, not just one, before moving forward. See you soon!

[@leoy8820]

@@patriciacoughlinphd1852 That's a new idea for me, I wish I heard this years ago! Thank you!

[@SevenRavens007]

Thank you so much for sharing these insights.

[@patriciacoughlinphd1852]

My pleasure

[@Amir-cs3wl]

Hi there, Thank you so much for taking the time to share and bringing this distinction to our attention :). I am wondering how taking " I know she didn't really wanne come to my house because she never preferred me ..." as a projection of the voice inside that says " you are not preferred ..." onto her mother, and at the same as externalization of the problem could be entertained.If I understand correctly, the main reason to consider this as externalization is because of lack of fragility and anxiety discharge that you mentioned about her, is that right? I'm having a bit of a hard time understanding this as mere externalization, I do appreciate you helping me see this with more clarity :).

[@patriciacoughlinphd1852]

It's a defense and can simply be blocked. "We actually have no way of knowing what was going on in your mother's head. All we know is that she didn't come to your house and you have feelings about it. Can we look at that?" We want to take the shortest route to an internal focus as possible. If the patients is able to drop the focus on what she imagines her mother was thinking and feeling and turn her attention inward, that's what we would do. It is response to interventions that will tell you how syntonic or dystonic the defense is. True projection involves distortion in reality. This patient was easily able to see she was making up a story and deflecting attention from her own feelings.

[@rikkehvelplund4591]

So happy for this post and for all your contributions. And i’m following Bidens inauguration today as Well. ❤️

[@patriciacoughlinphd1852]

So historic and hopeful - a woman VP at last!

[@SevenRavens007]

I’m wondering whether these map onto the triangle of persons. Eg. Externalisation arises in the context of the therapist; projection in the context of current persons; and transference in the context of past persons. Not at all sure but might help figuring out which is which, clinically

[@patriciacoughlinphd1852]

I don't see it that way. One can project or externalize in any relationship. Transference is typically restricted to the the relationship with the therapist.

[@taniasuzukipichlercastilho2900]

Thanks Patricia!! I've been repeatedly running into this question in my mind when i'm with certain clients and was SO glad to see your input here! I've been to a couple of workshops on projection and i'm sitting with the idea that if there is a sigh there is no projection... What would you say to that? when is that not the case?

[@patriciacoughlinphd1852]

Projection is when the patient denies a feeling or wish within and sees it as existing in your. For example, they are angry but deny it and are convinced you are angry with them. So the patient is seeing you as a disowned part of themselves. In contrast, with transference, the patient is seeing you as someone else - perhaps a harsh father or weak mother. It's important to distinguish between the two so you know how to proceed.

[@jrti001]

Would a patient who worries about the therapist existing outside the the therapy session be a form of projection?

[@patriciacoughlinphd1852]

I'm not sure I understand the question. Could you clarify?

[@jrti001]

@@patriciacoughlinphd1852 Ok, maybe I'm misunderstanding what projection means. I'll let it go. It's a bit complex to explain. Thank you.

[@patriciacoughlinphd1852]

I would suggest watching the video on the distinctions between externalization, transference and projection.

[@rickturnr]

Anna Freud didn't have a college degree