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Defense Mechanisms: Should Allow Patients To Control Their Own Care and Not Engage in A Battle of Wills

The document discusses several unconscious defense mechanisms: 1. Dissociation - Separating a mental or behavioral process from the rest of one's psychic activity. Patients with borderline personality disorder may experience derealization or depersonalization under stress. 2. Intellectualization - Remembering facts without emotion. Obsessive-compulsive personalities use this mechanism and respond well to rational explanations. 3. Projection - Attributing one's own unacknowledged feelings to others, often appearing as prejudice or hypervigilance. Therapists should acknowledge mistakes to build trust. 4. Splitting - Dividing people into all-good or all-bad categories, as seen in in

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Rhea Andrea Uy
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26 views

Defense Mechanisms: Should Allow Patients To Control Their Own Care and Not Engage in A Battle of Wills

The document discusses several unconscious defense mechanisms: 1. Dissociation - Separating a mental or behavioral process from the rest of one's psychic activity. Patients with borderline personality disorder may experience derealization or depersonalization under stress. 2. Intellectualization - Remembering facts without emotion. Obsessive-compulsive personalities use this mechanism and respond well to rational explanations. 3. Projection - Attributing one's own unacknowledged feelings to others, often appearing as prejudice or hypervigilance. Therapists should acknowledge mistakes to build trust. 4. Splitting - Dividing people into all-good or all-bad categories, as seen in in

Uploaded by

Rhea Andrea Uy
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Defense Mechanisms

unconscious mental processes the EGO uses to RESOLVE CONFLICTS among the abolish anxiety and depression
4 lodestars of inner life. at the conscious level
1. instinct (wish or need)
2. reality increased conscious awareness of anxiety and depression which is a primary reason in
3. important persons reluctance to alter behaviour.
4. conscience

• people labelled schizoid


• eccentric
• lonely or frightened
• seek solace and satisfaction within themselves by creating imaginary lives, imaginary friends
• strikingly aloof
• UNSOCIABLENESS lies in FEAR OF INTIMACY
Should maintain a quiet, reassuring, and considerate interest without insisting on reciprocal responses.
Recognition of patient's fear of closeness and respect for their eccentric ways are both therapeutic and useful

unconscious defense mechanism involving separating a mental or behavioural process from the rest of
the person's psychic activity.
patients with borderline PD may demonstrate dissociation during times of INCREASED STRESS, including derealization or
depersonalization.

• separation of ana idea or memory from its attached emotion.


• characteristic of CONTROLLED, OLDERLY persons, often labeled OBSESSIVE-COMPULSIVE
PERSONALITIES
• they remember the truth in fine detail but WITTHOUT AFFECT
• IN CRISIS: patients show intensified self-restraint, overly formal social behavior, and obstinacy.
○ they respond well to precise, systematic, and rational explanations and value efficiency,
cleanliness, and punctuality.
should allow patients to control their own care and not engage in a battle of wills.

• patients attribute their unacknowledged feelings to others


• patients often manifest with excessive fault finding and sensitivity to criticism and may appear as
prejudiced, hypervigilant, and injustice-collecting.
○ therapist should not respond with defensiveness and argument.
○ therapist should frankly acknowledge even minor mistakes on their part and should discuss possibility of future
difficulties.
○ HELPFUL: strict honesty, concern for patient's rights, maintaining same formal, concerning distance as used to
patients who use fantasy defenses
NOTE: You need not agree with patient's injustice-collecting, but they SHOULD ASK whether both can agree to
disagree.
▪ is helpful where clinicians acknowledge and give paranoid patients full credit for their feelings and
perceptions
▪ neither dispute patients' complaints nor reinforce them but agree that the world they describe is
conceivable
▪ interviewers can then talk about real motives and feelings, misattributed to someone else, and
begin to cement an alliance with patients.

• patient divides persons toward whom they are, or have been, ambivalent into good or bad.
○ example: an inpatient may idealize some staff members and disparage others.

○ when staff anticipates the splitting process, discuss at staff meetings to inform everyone, and gently confront
the patient with the fact that no one is all good or all bad.

• patients directly express unconscious wishes or conflicts through action to avoid being conscious

Psychiatry Page 1
• patients directly express unconscious wishes or conflicts through action to avoid being conscious
of either the accompanying idea or the affect.
• EXAMPLES: tantrums, apparently motiveless assaults and pleasureless promiscuity
• behavior occurs outside of reflective awareness and thus, acting out appears to observers to bee
UNACCOMPANIED BY GUILT
○ BUT, when acting out is impossible, the conflict behind the defense may be accessible.
• the clinician faced with acting out must recognize that the patient has lost control, the patient will mishear
anything you say
• PARAMOUNT IMPORTANCE: getting the patient's attention
• If you feel unsafe with a patient acting out during an interview, you may simply leave and ask for help if
necessary.

• appears mainly in borderline PD


• consists of 3 steps;
1. Patient projects an aspect of the self onto someone else.
2. Projector then tries to coerce the other person into identifying what they projected.
3. Recipient of the projection and the projector feel a sense of oneness or union.

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