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

2. 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.

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

4. “Hmmmmm…..that doesn’t seem normal.”

5. 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

6. 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"

9. 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.)

10. Ego-centrism, Separateness, and Constancy

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

12. 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)

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

14. 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.

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

16. 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 .

17. 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”

18. 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.

19. 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.

20. 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.

21. 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

22. 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

23. 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

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

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

26. Rationalization

27. 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”

28. Compartmentalization

29. Undoing Turning against Self

30. 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”.

31. Displacement Reaction Formation

32. 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……”

33. Acting Out Sexualization

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

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

36. Let’s meet Dr. McWilliams

37. How much do you remember?
Please take out your device (phone, pad, laptop) and go online to
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!

38. 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

39. Resources
Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process, Guilford Press, 1999
Vimeo: 52 minutes, Dr. Nancy McWilliams, Ph.D.
Website Defense Mechanisms