From the author: I would like to share my favorite article by Anton Ezhev. At the lowest level of the ego development continuum, hostility can manifest itself in the form of freely expressed rage. At higher levels of ego development, in most cases, more defense mechanisms appear and the expression of hostility becomes more passive and complex. Stephen Johnson “Character Psychotherapy”. Dear colleagues! Let me present to you two clinical cases described by students of the Psychiatry for Psychologists course. What they have in common is the phenomenology of aggression in the client-therapeutic relationship. At the same time, aggression, being a general phenomenon, has significant differential diagnostic differences. To maintain privacy, biographical information and other recognizable details have been adjusted. Case No. 1. Briefly about the client Elena, a young woman, 29 years old, married for 6 years, raising a daughter 4.5 years old. Outwardly, Elena gives the impression of a well-groomed woman with a pleasant appearance. At the first and subsequent meetings, she smiles, is generally friendly, approachable, and arrives on time. Request Elena’s main difficulties are focused on her professional activities. She works as a realtor and experiences serious difficulties in organizing her time, “constantly does not have time”, “does everything at the last moment”, “is torn between meetings with clients and household responsibilities”, “puts off preparing documents for transactions until the last minute”, etc. d. and wants to understand why this is happening. The work took place once a week, with the condition that meetings be canceled or rescheduled no later than 24 hours in advance. Progress of therapy The client came regularly, did not cancel or reschedule meetings. For the first 3 months of work, the impression was created about Elena as a “good client” with whom it was “pleasant and promising to work”, however, in the background there was gradually growing distrust in the therapeutic situation of comfort and the feeling that the primary request for problems in organizing time was solved rather in a consultative, training format and practically did not concern client-therapeutic relationship. In response to the therapist focusing on this point: “it seems to me that in sessions we discuss your difficulties in life, but as if we don’t touch on the aspects of our interaction with you,” the client tensed, her usual smiling disappeared and she answered quite sharply: “No I understand why I need this here? I wouldn’t like to experience unnecessary feelings.” The therapist tried to clarify what feelings we were talking about, and in response he heard: “About all the feelings. It’s already hard for me. At work you have to be nice and friendly to everyone. At the same time, you come across different clients, sometimes they just drive you into a frenzy, they annoy you with their calls and complaints, but you have to hold on in order to earn money.” In response to this, the therapist suggested that it seemed that the client had accumulated a lot of anger and asked if Elena was trying to be sweet, friendly and in therapy, as she does in her work and, perhaps, in other areas of life (family, relationships, etc.) and, perhaps, in addition to this goodwill in therapy, she may have other feelings towards to the therapist and the therapy process. The client thought in response and answered, without looking the therapist in the eyes: “I don’t think I have any negative feelings here, if they appear, I’ll say so.” At the same time, the position was tense, the fists were clenched, it felt like the therapeutic situation was “heating up”, the client was looking at the clock, as if assessing how much longer she needed to “hold out”. At that moment, her face “lit up” and she remembered that she wanted to discuss a “very important topic,” which turned out to be a standard topic about work, in which the energy and intensity of the previous episode disappeared without a trace. The session ended, the client left with her usual smile and thanks therapist for the work done, the therapist was left with the feeling that the client’s defenses had prevailed and the imaginary well-being of the session “saved” their relationship from something important that should be clarified in further work. Furtherthe dynamics reflect the dramatic outcome in working with Elena. She was late for the next session, which had not happened before. When the therapist tried to clarify the connection of this phenomenon with the events of the previous session and perhaps with her request about the “organization of time,” the client, without losing her usual smile, very “honestly” and rationally explained everything, various kinds of circumstances, which, of course, were in no way connected with the previous meeting, then very quickly formulated a request for a session and worked “productively” with it. Elena postponed the next session due to the child’s illness with the agreement that she would inform when the girl got better in order to discuss the date and time of the session. Elena missed two sessions , then wrote, apologizing that she “disappeared” and made an appointment, but after a couple of days she canceled the meeting, citing workload and an open question about the next meeting. Two weeks later, Elena sent a message in which she said that, unfortunately, she would come now she doesn’t have the opportunity - she’s very busy at work and with a child, but at the same time contradictoryly informing that she “really needs psychological help” more than ever. In response to a message from the therapist, which suggested finding the strength and time to meet and receive this help, and a clear date and time of the session were also indicated, there was Elena’s “deathly” silence, which gave birth to a lot of feelings in the therapist: confusion, resentment, a feeling of deception, which turned into indignation and rage, which, however, the therapist tried to restrain and transformed into a polite clarifying message: “Good afternoon , Elena! You did not respond to my previous message. Are you all right?” Which also remained unanswered. There were no further messages from Elena. The therapy has formally ended. Case No. 2. Briefly about the client Natalia, age at the time of description of the case 38 years. Self employed. Married, in marriage since 21 years. I have a son, 18 years old. They live together with the client’s mother. Peculiarities of the first meeting: The client looks chaotic, emotions quickly replace each other, she smiles, then frowns sharply, her behavior is demonstrative, excited, very charged affectively, irritation and indignation dominate. Asthenic physique, short stature , looks exhausted, as if “on the verge of a nervous breakdown.” Brightly made up, eyes lined. Dressed vulgarly, intense makeup, exaggerated sexualization in appearance and clothing. The request is vague: “I feel very bad, help.” She talks about how “her whole life is dedicated to her husband, he is the only man in her life, she gave him all her time and energy, but he betrayed her, she gave up the best years of her life, devoted herself entirely, and he acted so vilely towards her and cheated on her.” Complaints to “bad sleep”, “I toss and turn at night, I hear him (the husband) snoring and snoring, and I’m shaking all over, I want to kill him, such a bitch, take a knife and tear him into pieces, the bastard.” Also complaints about “ bad emotional state,” which she was never able to clarify, answering the therapist with irritation: “I just feel bad, what’s not clear here?” Can’t find a place for herself, feels a chronic emptiness inside, is scared, painful, has no idea how to survive betrayal. Progress therapy The therapist's countertransference at the first and most subsequent sessions included confusion, a feeling of fear of the client and a feeling of paralysis, the inability to work as usual. Natalya's social and family life is chaotic, saturated with aggression and a chronic feeling of injustice towards her and the hostility associated with this. She has no experience of permanent work, stayed for a maximum of six months, entered into serious conflicts and usually quit before they had time to fire her. She often failed interviews, arguing with employers: “One asked me about family life. What the hell is his business? I expressed this to him directly.” He does not reflect on his own aggressiveness; he believes that there are only brutes around and it is impossible to live in such a world. Currently engaged in trading household chemicals and cosmetics on the market. Stable friendly relations alsoNo. The descriptions of others are chaotic and very contradictory. All people quickly disappoint the client, and in situations of any kind of tension and uncertainty, she ragefully devalues ​​people and breaks all ties with them. The therapist suggested that Natalya consult a psychiatrist so that at the initial stage of work she could stabilize her emotional state, improve sleep and functioning in general. In response to this, she fell into a frenzy and said, “Do you mean, like my mother and all these bastard relatives, you consider me mentally ill? They pay you that kind of money, so treat me.” In response to clarification of who was paying for the therapy, it turned out that it was the husband who was doing it. When the therapist asked how the client was feeling about the fact that there had been a betrayal and she had so many negative feelings towards him, she replied that “it’s his doing, so let him sort it out, I don’t give a damn about him.” The therapist asked: “If “You don’t give a damn, then why are you so worried about it?” The answer was tense silence and an abrupt switch of the topic of conversation by the client. The next four meetings further demonstrated the severity of Natalia's disorders. She was late for all meetings, and at the same time delayed the completion of the sessions, ignoring the therapist’s comments about the time. There was a feeling of total control on the part of the client. Monstrous events took place in external life. In one of the scandals with her husband, she forced him to “atone for treason with blood,” forcing him to cut himself with a knife on his forearm; in another case, during a quarrel in the car, while driving into the oncoming lane, the husband managed to forcefully turn the steering wheel back. In one of the sessions, she admitted that she had a sexual relationship with a man much younger than the client, took a lot of intimate photos that she sent to her husband, and one day she forced him to take him to her lover in a car and wait under the house to take him back after she “fucked” .During these sessions, the work was filled with depreciation, anger and misunderstanding “what is that kind of money being paid for?” At the end of the sessions, the client left “with nothing.” The client simply did not come to the sixth meeting without warning. The therapist’s countertransference was dominated by a feeling of relief, with the experience of being “used”, tired, devalued, as well as strong resistance and anxiety to get in touch with the client in order to clarify her non-arrival. In response to the message The therapist received no response from the client. The therapy was completed at this point. Analysis of cases The first case The first case demonstrates problems with aggression in a client of a neurotic level of personality organization, belonging rather to a masochistic character and a related problem in the expression of aggression, which is retained, Elena endures a lot and restrains her anger (defensive mechanism retroflection ). Aggression is avoided (deflection, rationalization) in relationships at work and therapy, translated into exaggerated politeness and goodwill (reactive education) and ultimately acquires a typical passive form of expression in the form of tardiness, cancellations and postponements of sessions, an influx of life problems (children, finances), which are usually the unconscious authorship of the client himself. This happened at the very moment when the therapist came out of fusion with the client, became “uncomfortable” and indicated his therapeutic interest in the situation, confronting her with the possibility of also being “uncomfortable” in therapy and talking about her experiences. The client was most likely acting out her usual avoidance mechanism. It can be assumed that her tardiness in work and life is also associated with passive aggression. But in general, we see that the client has no problems with the setting, boundaries, she demonstrates the highest defenses, her life is stable, her relationships at work and in the family are good. The countertransference is soft, her request is clear and psychologically understandable. The second case The second case is a typical example of problems with aggression in a patient with a borderline personality organization of a low level of functioning with traits of an infantile character type. We see that.