When the therapist says, ‘I sense you’re angry’, this is clearly something of an understatement. This slide shows something of what may happen when a patient feels exposed and humiliated. It may be that their rage and a desire to retaliate isn’t shown by them driving a tank into the therapist’s consulting room but there may be a wish to attack and sometimes this destructive impulse may carry with it omnipotent or omniscient fantasies of huge power to destroy which may have tank-like proportions in the patient’s mind. 

The therapist’s somewhat understated response to the patient’s attack or fight with help contains within it the idea of the importance for the therapist of recognising the patient’s destructiveness and their wish to attack without themselves retaliating. This is clearly easier said than done in the face of some extreme attacks from a patient, particularly if they approximate to a tank-like level of aggression.