1. Coping Mechanism in Psychosomatic

2. Ego defenses
When the conflicts in the unconscious rise to a heightened level the the conflicts threaten to become manifested in the conscious life of the person
This is a way to discharge the anxiety created between the unconscious conflicts

3. The tripartite model of the mind
Freud
Ego ID
Superego
The id is need gratifying and impulsive, instinctual
Hedonic drives for instance
Superego is roughly eq. to conscience
Determines that some needs are not consistent with an underlying view of one’s self (Ego ideal)

4. Ego
Ego is the mediator between the unconscious world of the Id and Superego and the conscious world of reality
The ego’s job is to mediate the struggle between the superego and id
When superego and id are in conflict the person experiences ‘signal anxiety’
Ego must convert the signal anxiety to defuse it and make it less threatening.

5. Ego Defenses
If the signal anxiety cannot be defused it may overwhelm the ego and allow the primitive primary process thinking of the unconscious to become manifested in the conscious life of the person

6. Enhanced Understanding of the Ego
Ego is the part of the mind that gives coherence
to experience;
Ego has an overall
unifying purpose that
leads to consistent
behavior and conduct;
Ego has a positive function
of maintaining good
performance and not just the
negative role of avoiding anxiety;
Ego defenses are adaptive
as well as maladaptive;
Ego is defined as a strong, vital, and
positive conscious force. It is the organizing
capacity of the person that leads to a strength
that can reconcile ambiguities and discontinuities.
Written and arranged by Dr. Gordon Vessels 2004

7. Developmental aspects
The Id is the earliest component of the psychodynamic apparatus
The infant is basically in a pleasure seeking mode of operating (sometimes this is confused with ‘sexuality’)
The infant also conceives of the world in a narcissistic fashion. Things exist only as they relate to him or her
At times the pleasure seeking runs into barriers in the outside world
This result in infants being confronted with reality
New skills and coping mechanisms develop

8. Orderly sequence of development
Normally there is an orderly sequence as the child matures
If significant trauma occurs the child may have difficulty learning the mechanisms that are normally learned at these times
Fixated – uneven development of ego function which results in a part of the ego retaining more primitive or immature function
Repetition compulsion – replay of events related to significant traumas

9. Stages
Oral
Anal
Phallic
Latency
Genital

10. There are characteristic defense mechanisms used in specifc stages
It is possible to describe defense mechanisms along a hierarchy of maturation- actually done first by Freud’s Daughter (Anna)
The defenses used provide some evidence for stages where there are fixations

11. Defense mechanism classification
Narcissistic
Immature
Neurotic
Mature
Denial
Acting out
Displacement
Altruism
Projection
Regression
Dissociation
Humor
Distortion
Passive-aggressive behavior
Reaction formation
Sublimation
Splitting
Schizoid fantasy
Repression
Anticipation
Somatization
Isolation
Suppression
Introjection
Rationalization
Asceticism
Hypochondriasis
Sexualization
Blocking
Intellectualization
Denial-avoiding awareness of some painful aspect of reality by canceling sensory data
Projection- attributing your thoughts or feelings to someone else because they are uncomfortable
Distortion-Grossly reshaping reality to suit your inner needs. Delusions, hallucinations, etc.
Acting out-expressing an unconscious wish through action to avoid becoming consciously aware of it. Impulsively giving in to an unconscious impulse to avoid the tension that builds up when you avoid it.
Regression- a return to an earlier period of libidinal gratification. Normally important for relaxation and other normal aspects of behavior such as sex, sleep, etc
Passive-aggressive behavior- Expressing hostility toward others indirectly by passive avoidance, masochism, procrastination etc.
Schizoid fantasy- Indulging in an autistic belief system in order to resolve conflict and obtain gratification. Intamacy is avoided. Appears eccentric.
Somatization-Converting signal anxiety into bodily symptoms to express internal conflicts
Introjection- internalizing the qualities of another person. Identification with the aggressor is a classic example.
Blocking-temporary blocking of thinking. May resemble repression.
Hypochondriasis- Exagerating or overemphasizing an illness for the purpose of avoiding an uncomfortable internal conflict
Displacement- Shifting an emotion or characteristic from one idea to another. Displacement allows the symbolic representation of the original unconscious idea in a less threatening fashion. Becoming a surgeon instead of a murderer.
Dissociation- Temproary but drastic modificantion of a person’s character or sense of identity to avoid distress. Ex: Multiple personality, fugues, etc.
Reaction formation- transforming an unacceptable impulse into the opposite. (obsessional characters) Paranoia
Repression- expelling an idea or feeling from conscious awareness. NOT SUPPRESSION
Isolation- splitting an idea from the affect that accompanies it. The affect remains repressed. (Common defense in antisocial PD)
Rationalization- Offer rational explanations to justify thoughts ideas, feelings and behaviors that may otherwise be unacceptable
Sexualization- Endowing an object or function with sexual significance.
Intellectualization- excessively using intellectual explanations to avoid affective expression or experience
Altruism- Using constructive and instinctually gratifying service to others to undergo a vicarious experience
Humor-Using comedy to overtly express feelings and thoughts without personal discomfort or immobilization and without producing an unpleasant effect on others
Sublimation- Achieving impulse gratification and retention of goals but altering a socially objectionable aim or object to a socially acceptable one.
Anticipation-Realistically anticipaing or planning for future inner discomfort
Suppression- conscious postponing attention to a conscious impulse or conflict.
Asceticism- eliminating the pleasurable effects of experiences. Moral element assigning values to specific pleasures.

12. Other immature defense mechanisms
Splitting-the tendency to see things as either black or white
The rigidity prevents the normal flexibility which is necessary in dealing with ambiguity
Borderline and narcissitic PD use this
Magical thinking-
Undoing

13. Some characteristic defenses used in specific stages
Oral- narcissistic defenses
Projection, denial, distortion
Anal-
Identification, undoing, reaction formation, isolation, regression
Phallic / oedipal
Intellectualization
Latency
Symbolization, sublimation

14. Primary Repression
Conflict arises when the ID’s drives threaten to overwhelm the controls of the Ego and Superego
Ego pushes ID impulses deeper into the unconscious via repression
Material pushed into unconscious does not sit quietly- causes symptoms
((Show clip from PBS))

15. Classification of Defenses
Mature
Immature
Narcissistic
Neurotic

16. Mature Defenses
Altruism
Anticipation
Humor
Sublimation
Suppression

17. Altruism
Unselfishly assisting others to avoid negative personal feelings

18. Anticipation
Thinking ahead and planning appropriately

19. Sublimation
Rerouting an unacceptable drive in a socially acceptable way; redirecting the energy from a forbidden drive into a constructive act
A healthy, conscious defense
Ex. Martial Arts

20. Suppression
Deliberately (consciously) pushing anxiety-provoking or personally unacceptable material out of conscious awareness

21. Immature Defenses Acting Out Somatization Regression Denial Projection
Splitting
Displacement
Dissociation
Reaction Formation
Repression
Magical Thinking
Isolation of Affect
Intellectualization
Rationalization

22. Acting out
Behaving in an attention-getting, often socially inappropriate manner to avoid dealing with unacceptable emotions or material

23. Somatization
Unconscious transformation of unacceptable impulses or feelings into physical symptoms

24. Regression
Return to earlier level of functioning (childlike behaviors) during stressful situations
Ex. Kids regress after trauma

25. Denial
Unconsciously discounting external reality

26. Projection
Falsely attributing one’s own unacceptable impulses or feelings onto others
Can manifest as paranoia
((Use Seinfeld clip of George at dinner table (lobster dinner))

27. Splitting
Selectively focusing on only part of a person to meet a current need state; seeing people as either all-good or all-bad
Serves to relieve the uncertainty engendered by the fact that people have both bad and good qualities
Considered normal in childhood

28. Displacement
Redirection of unacceptable feelings, impulses from their source onto a less threatening person or object
Ex. Mad at your boss, so you go home and kick the dog
Show video example

29. Dissociation
Mentally separating part of consciousness from reality; can result in forgetting certain events
Ex. Dissociative amnesia
((Show clip of MPD from Richard Gere movie- Primal Fear))

30. Reaction Formation
Transforming an unacceptable impulse into a diametrically opposed thought, feeling, attitude, or behavior; denying unacceptable feelings and adopting opposite attitudes
Ex. Person who loves pornography leads a movement to outlaw its sale in the neighborhood
Review video tape of Skit on McElroy and defense mechanisms to see which ones we learned

31. Repression Keeping an idea or feeling out of conscious awareness
The primary ego defense
Freud postulated that other defenses are employed only when repression fails

32. Magical Thinking
A thought is given great power, deemed to have more of a connection to events than is realistic
Ex. Thinking about a disaster can bring it about
Can manifest as obsessions

33. Isolation of Affect
Stripping an idea from its accompanying feeling or affect
Idea is made conscious but the feelings are kept unconscious

34. Intellectualization
Using higher cortical functions to avoid experiencing uncomfortable emotions; thinking without accompanying emotion

35. Rationalization
Unconscious distortion of reality so that it’s negative outcome seems reasonable or “not so bad, after all” (making lemonade out of lemons)
Giving seemingly reasonable explanations for unacceptable or irrational feelings