Psychoanalytic Diagnosis Understanding Personality Structure in the Clinical Process By Nancy McWilliams, Ph.D. 1999 UNDERSTANDING OUR DEFENSE MECHANISMS

PsychoAnalytic Theory According to Anna Freud,we all have preferred defenses that have become integral to our styles of coping. Therapy aims to disarm defenses that no longer serve us in adulthood.

Who Wrote This? Nancy McWilliams, Ph.D. 1999

“Hmmmmm…..that doesn’t seem normal.”

Why Defenses Make Sense Defenses begin as healthy, creative adaptations, and continue through our lifetime, to accomplish 2 things: a.) avoid or manage some powerful, threatening emotion, like anxiety or grief; b.) maintain self esteem

Personality and Character This preferred and automatic reliance on a particular defense or set of defenses is the result of a complex interaction of four factors: a) temperament b.) nature of the stresses that one suffered in early childhood c.) the defenses modeled/taught by parents d.) the experienced consequences of using the defenses, or "reinforcement"

The difference between “primary” and “higher order” defenses Primitive defenses operate in a global way, and involve the boundary between the self and the outer world. Must be preverbal, lack of reality principal, lack of separateness and constancy Secondary defenses or more mature or advanced defenses deal with internal boundaries, like those between the ego and the superego, and the id. (between the OBSERVING parts and the EXPERIENCING parts of the ego.)

Ego-centrism, Separateness, and Constancy

The most common “lower order”, primative defenses: - Denial - Withdrawal - Omnipotent control - Idealization - Devaluation - Ego-splitting - Projective identification

Primitive Withdrawal When an infant is overstimulated or distressed, he will fall asleep to withdraw, as a self protective response, (depending on the baby’s temperament)

Denial “This is not happening”. Helpful in crisis or emergencies. People who use denial to an unhealthy degree are referred to as manic.

Omnipotent Control Healthy: Unhealthy: A sense that one can - Fantasy that one has influence the world, control of the world, has agency, competence - Grandiosity - Manipulative Exerting one’s will over others with no ethical concern is considered sociopathic.

Idealization One way youngsters cushion themselves against overwhelming fears is to believe someone benevolent, all powerful, is in charge. All of us idealize.

Devaluation “The bigger the illusions, the harder they fall.” Since nothing in life is perfect, ideals are doomed to devalue. The more an object is idealized, the more radical the devaluation .

Projection Introjection Lack of psychological boundary between self and the world What is inside is misunderstood as coming from the outside What is outside is misunderstood as coming from the inside i.e. “Identification with the aggressor”

Projective Identification A fusion of projective and intro-jective mechanisms The patient views the therapist in a distorted way (based on his/her past object relations), AND pressure is exerted on therapist to behave in a way congruent to that unconscious fantasy.

Ego-splitting Primary way that young human beings organize experience, without any ambivalence. Things are all good, or all bad. Ego splitting is a powerful and appealing way to make sense of confusing or threatening experiences Splitting always involves distortion.

Dissociation Normal reaction to trauma – cuts off pain, terror Repeatedly traumatized, learn to habitually dissociate, can result in multiple personality However, traumatized people may confuse ordinary stress with life threatening circumstances, and become immediately amnesic, or totally indifferent.

The most common “higher order”, secondary defenses: - Repression - Regression - Isolation - Intellectualization - Rationalization - Moralization Compartmentalization - Undoing Turning against the self - Displacement Reaction Formation - Reversal Identification - Acting out Sexualizaiton - Sublimation

Repression Forgetting or ignoring thoughts, pushing them down into subconscious Becomes problematic only when it fails to do it’s job, i.e. PTSD recurrances

Regression Sliding backwards in maturational age Part of the separation process, ebb and flow in developmental phase, especially after attaining new level Somatization/sickness as an excuse

Isolation “Psychic Numbing” Intellectual defense. The experience is not totally obliterated from conscious experience, but the emotional meaning is cut off.

Intellectualization Separation of affect from intellect Not, I have NO feelings, but talks about his/her feelings rationally Handles emotional overload

Rationalization

Moralization One unconsciously seeks cognitively acceptable grounds for one’s direction. Feels it is “one’s duty” or moral obligation to proceed. “It builds character”

Compartmentalization

Undoing Turning against Self

Displacement The transfer of negative emotions from one person to another, unrelated person or thing (boss, to kids) “I did so poorly on my test, I’ll go home and kick the dog”.

Displacement Reaction Formation

Reversal Identification Re-enacting a situation that switches one’s position from subject to object, vicariously satisfying Unconscious wish to be like a valued person…. “The yearning of adolescents to find heroes whom they may emulate in their effort to address the complex demands of looming adulthood……”

Acting Out Sexualization

Sexualization Endowing an object or function with sexual significance it doesn’t possess Warding off anxieties associated with prohibited impulses

Sublimation Unacceptable impulses are transformed into behaviors that ARE acceptable by society

Let’s meet Dr. McWilliams https://vimeo.com/111584559

How much do you remember? Please take out your device (phone, pad, laptop) and go online to www.kahoot.it Enter the PIN # shown and choose a nickname for yourself. Wait until you see your name show up on the big projection screen Answer the questions as fast as you can…you get points for speed as well as accuracy. Good luck!

Anyone using defense mechanisms? Good for you! 1.) Well, games may be Intellectualization entertaining, but they don’t measure anything. 2.) I wasn’t ready. Denial 3.) I chose not to play. Withdrawal 4.) Oh! Were we playing a game? Dissociation

Resources Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Guilford Press, 1999 http://www.cppnj.org/article_mcwill.php Vimeo: 52 minutes, Dr. Nancy McWilliams, Ph.D. https://vimeo.com/111584559 Website Defense Mechanisms http://www.simplypsychology.org/defense-mechanisms.html