Download - Intro To Defenses
SELF ASSESSMENT
• What is the one thing that stood out to you from your last class? Your professional take away?
• How confident are you to be able to identify a client’s somatic pathway of emotion?
• How comfortable are you identifying a client’s anxiety pathway?
• What is the purpose of identifying the pathway of anxiety discharge?
• What concerns do you have so far?
KEY PRINCIPLES REVIEWED
• This is about validation and acceptance. It should never be construed as critical of the patient
• The main guide to all of your interventions is this: “how can I reach through and connect with the healthy part of the person who is stuck underneath defense and anxiety.”
• Relentless efforts to attach (pressure) mobilize all the attachment related feelings (Complex Transference Feelings) and mobilizes the Unconscious Therapeutic Alliance (UTA).
• Make it Simple:
• Reach to the person stuck underneath (pressure)
• If they defend, help them to see it and to stop
• If they go flat, help lift them up.
Unconscious Therapeutic
Alliance
Complex T Feelings
“Unlocked”
Resistance
PR P RP
Th R
COMPLEX TRANSFERENCE FEELINGS (CTF)
• Complex feelings mobilized in therapy which are linked to the past bond, trauma, pain, rage and guilt about rage.
• Includes deep appreciation for the therapist persisting with them for the best outcome. As well includes irritation toward the therapist (T) because of the challenge to resistance.
OVERVIEW OF DEFENSES
DEFENSES
• Everyone defends
• Ways we learned to regulate affect and relationships
• Ends ups causing and perpetrating pathology
• Defenses block feelings, wishes, impulse, goals
• Defenses take energy
• Defenses block closeness with others
• Defenses are habitual and unconscious
SYNTONIC VS DYSTONIC
• Syntonic defenses: Client does not see as a problem or how it hurts them and relationship. “that is just how I am”
• Dystonic defenses: Client sees as a problem and wants to change. Not use the defense anymore. Has “turned against” the defense
• We need to help the client turn their defenses from Syntonic to Dystonic. Otherwise, they will feel attacked and misunderstood.
DEFENSES
• We will divide the defenses into 2 Categories: Tactical and The Major Resistances
1. Tactical
2. Major Resistance:
1. Isolation of Affect
2. Repression
3. Projection/Splitting
4. Superego Pathology
1. TACTICAL DEFENSES
• Small “tactics” the client uses to throw off the therapist
• They are loosely held and fade with either blocking them, ignoring them, or pressing against them
• These are the most common ones:
Defense Example
Cover words “It bugged me”, “I feel embarrassed” (avoiding closeness), “I feel angst”, “I Feel upset
Lack of focus, vagueness,
evasive
“There is lots going on”, “It’s a relationship problem of sorts”, “I seem to have some emotional issues”
Indirect Speech “I was probably mad”, “I guess I feel angry”, “It could be that”
Diversification Jumping around from topic to topic, example to example, etc
Passive “I am not sure where to start. What do you think?”
Externalization “My mother just needs to get in therapy” “If I could only find a job, life would be better”
Body movements Smiling, laughing, closing up, turning away, posture, eye contact, etc.
Common Tactical Defenses
MAJOR RESISTANCES
1. ISOLATION OF AFFECT
• Part of major resistance (tightly held, will not go away by ignoring, etc)
• Person will intellectualize and “isolate” affect from experience
• Associated with striated anxiety
CUT OFF FROM EXPERIENCE OF FEELINGS
ISOLATION OF AFFECT
Defense Example
Rummination Overly thinking and speculating
Intellectualization, rationalization Using thoughts or ideas instead of feelings
Detached Aloof, uninvolved, blank,
Passive Waiting on you to take the lead, not invested
Slowing down Longer pauses between speech, less output
Arguing Keeping things emotionally detached “why should I look at my feelings. I need tools”
Negation “I am not angry”, “I didn’t want to punch him”, I don’t know what I am feeling”, etc.
Body movements Turning away, eye avoidance, closed posture
2. REPRESSION
• Helpless, hopeless
• Self-attack, beating up self
• Getting angry at self
• Shutting down
• Weak, depressed
• Associated with Smooth Muscle
REPRESSIVE DEFENSES
RAGE IS TURNED AGAINST THE SELF. RESULTS IN SHUTTING DOWN FEELINGS
CLIENT WILL POWERING DOWN, CRUMBLING, GET WEAK, ETC Self
Repressive Barrier
Feelings
REPRESSION
Defense Example
Shut downs feelings, denial
“I feel empty, I don’t have feelings”
Smooth muscle symptoms Sick at stomach, weakness
Helpless I don’t know what to do or how I feel. I can’t do this
Hopeless “It will never get better” “I am incurable
Self-attack, anger at self “I’m stupid, I deserve this” “Who would like someone like me”
Weepy Tears that really cover anger, helpless
Body movements Looking flat, depleted, lack of tone and energy, depressed
3. PROJECTION AND SPLITTING
• Projection: Putting “out there” one’s feelings and impulses.
• Splitting: Splitting off contradictory views/feelings. Holding one-dimensional view of self or people
• Precludes complex feelings and contradictory feeling states
• Associated with Cognitive Perceptual disruption
• Found with more severe and traumatized cases
Defense Example
Projection “I don’t trust you” “I think you are angry with me”
Projection “My mother and everyone just hates me”
Projection “The last session I felt like you were implying I just needed to get over it and quit being a baby about this”
Splitting“You are the worst therapist I have ever had. My last therapist was so
wonderful”
Splitting “My mother is a witch. I have no love at all for her”
Splitting “I hit the jackpot with my boyfriend. He is absolutely perfect in every way!”
Associated behavioral
manifestations
Temper tantrums, impulsive discharge of affect, impulsive behaviors, self-destructive behaviors
PROJECTION AND SPLITTING
4. SUPEREGO PATHOLOGY• Resistance of guilt
• Davanloo calls this the “Perpetrator of the unconscious”
• Represents a built-in need to defeat and sabotage treatment to avoid unconscious feelings and impulses.
• Driven by intense guilt over rage towards loved ones.
• Unconscious guilt punishes the client for his feelings: The client “harms” himself to avoid the guilt over wanting to harm attachment figures
• Results in damaged relationships, self-harm, depression, suicidality, lack of enjoyment in life, reduced insight into oneself, etc.
• Found mainly in High Resistant, Fragile, and Severe Fragile Clients
Defense Example
Self-harm Cutting, addictions, risky behaviors, impulsive, missing sessions
Anger at self, Self-hatred
“I can’t do anything right”, “I am so stupid” “I am worthless and unlovable”
Victim stance “What is the point of trying”, “I can’t do anything to change it”
Need to punish self
Self-sabotage Ignoring oneself, neglecting oneself
Devaluing self and others, defiant
Examples of Supergo Patholgy:
WORKING WITH DEFENSES GENERAL GUIDELINES
• In general, most defenses are at first treated as tactical, so stance is to ignore or block them, and continue with pressure. “tactical defenses are not worth your time”
• If they continue, then brief clarification, and continue with pressure: “feeling ‘like he does not understand you’ is a thought, but how do you feel towards him?”
• If they continue to return, then more direct clarification and challenge is needed.
• Flick vs Hammer—If you can remove a defense by “flicking it”, then no need to use a hammer. For example, if a fly lands your arm and you hit it with a hammer, then you hurt yourself. Match the degree of challenge with the persistence of defense.
CLOSED SYSTEM
• Pressure to feeling in a closed system will “Puff up” defenses
• Defenses that tend to close the system:
• Externalization
• Passivity
• Defiance and compliance
• “One down”
• Helpless
• Detachment
• Superego pathology
Closed system is when one or more defenses are in operation in the room and heavily blocking the work. You will not see a lot of signals when this happens
Identify the client response
Client response Defense type or feeling?
(sighs) Well, I guess it’s that some of the topics I have to raise today are worrysome, that is how I feel.
(sighs) Well, I guess I feels overwhelmed by this therapy already
umm, I am not sure what I feel, I don’t think I can feel my feelings. I am always like that
(sighs) Well, I feel like you just sit there and don’t offer much.
(sighs) Well, I feel like I just want to run away when you keep askingthat
(sitting calmly but looking afraid) Well, I just keep wondering about your intentions and what you want from me
(looking suspiciously) I don’t know, I keep analyzing this therapy approach and think you are disappointed with me for some reason
“I notice you are tense and anxious right now. What feelings generate this tension here with me?”
Client response Defense type or feeling?
Believe it or not, I just don’t know….maybe I can’t feel anything
I feel so stupid and angry at myself for not knowing what I feel
(getting weepy and choked up) “I never can do this right, I am such a failure. This is hopeless”
(Sigh) I am probably getting a little frustrated.
I feel an anger rising up from my stomach and would like to shake you right now!
(Smiles) Yes, I thought you might ask what I feel.
Continued…
SPECTRUM OF PSYCHONEUROTIC
DISORDERS
PATTERNS OF PROBLEMS FROM ATTACHMENT TRAUMA
1. Low Resistance2. Moderate Resistance3. High Resistance
4. High Resistance with Repression5. Mild- Moderate or Severe Fragile Character Structure: repression,
splitting, and projection dominant
Spectrum of Psychoneurotic Disorders
Fragile Spectrum
THE LOW RESISTANT PATIENT: OPEN ACCESS IS ALREADY THERE
• Low Resistant patients come with an alliance in place —-there is no Rage, thus no Major Resistance
• Only have tactical defenses• They go to the issue then dance around it
until you encourage them to feel the grief about the loss in the past.
• 5 percent of office referrals• 1-3 sessions
Davanloo, H. 1995. Abbass 2002
LOW RESISTANT PATIENT
Grief
Tactical Defenses
Eg. Maybe, perhapsEg. Kind of, a little
Eg. vaguenessEg Smile
No Rage= No Major Resistance
Only Tacticals
MODERATE RESISTANT
• With more resistance, the patient brings more defenses that obstruct the process
• Pressure is needed to mobilize Complex Transference Feelings (CTF)
• Resistances mount and need to be clarified, blocked or challenged
• Presence of Violent and/or Murderous Rage, Guilt, Grief
• 5-10 sessions
Davanloo, H. 1995. Abbass 2002
MODERATE RESISTANT CLIENT
Violent Rage, Guilt, Grief, Craving
Major Resistances: Isolation of affect
Eye avoidanceDetaching
RationalizingEg Smile
HIGHLY RESISTANT PATIENT
• They have major resistances and go to resistance in the Transference
• Heavy focus in the Transference is needed• Standard intervention is Pressure, clarification,
challenge, Head-on-collisions• Small breakthroughs first to weaken the resistance • Later in process typical breakthroughs of MR or PMR in
the T which transfer the image to the past figure• Primitive Murderous Rage, Guilt, and Grief/pain, love• 1/3 of office referrals• 15-25 sessions
THE HIGHLY RESISTANT PATIENT: THE LOCKED UNCONSCIOUS
Murderous Rage and Guilt
Major Resistances
Slowing downHelpless
ExternalizingDefiance
Grief
ArguingDevaluing
HIGH RESISTANCE WITH REPRESSION
• Instead of feeling rage, it is repressed into the body
• In face of feelings, client goes “flat”, loses tone and energy, instant repression takes place. Often “weepy”
• Will often have physical symptoms: IBS, Stomach upset, migraines
• Anger is turned inward to protect attachment figures from the anger
• Common among depressed clients
DONEC QUIS NUNC
HIGHLY RESISTANT PATIENT WITH REPRESSION
Primitive Rage, Guilt, Grief, Craving
Major Resistance: Repression
RepressionGoing flat
Hopeless
FRAGILE CHARACTER STRUCTURE
• Severe trauma plus weak attachment
• Cognitive disruption when anxious
• Primitive defences: projection, splitting, dissociation, regressive defences
• Lack clear sense of self
• Self-harm common (cutting, drugs/alcohol, acting out)
• 25% of office referrals
• 45-200 sessions to treat
Davanloo, H. 1995. Abbass 2002
Dr Allan Abbass 2017
Pressure MODERATE RESISTANCE
STRIATED MUSCLE ANXIETY PLUS FEEL COMPLEX
TRANSFERENCE FEELINGS
HIGH RESISTANCE
Depression, smooth muscle anxiety or motor conversion
HIGH RESISTANCE WITH REPRESSION
COGNITIVE-PERCEPTUAL DISRUPTION OR
PRIMITIVE DEFENSES
FRAGILE CHARACTER STRUCTURE
GO FLAT: No striated muscle anxiety
Capacity Building Formats
Repeated unlocking, working through,
termination
STRIATED MUSCLE ANXIETY PLUS FEEL COMPLEX
TRANSFERENCE FEELINGS
BREAKTHROUGH OF GRIEF ABOUT LOSS
LOW RESISTANCE
Complete treatment In a few sessions
Inquiry
Resistance Rises
Resistance crystallizes in the transference
Clarify, Challenge,
Head on Collision