1. Coral Tree July 07 Beyond “Can’t or won’t?” How an understanding of psychological defence mechanisms can assist in understanding and responding to “resistant” students Peter Krabman Medical Director Coral Tree Family Service July 2007

2. Coral Tree July 07 Psychological defences “Defence mechanisms (or coping styles) are automatic psychological processes that protect the individual against anxiety and from the awareness of internal or external dangers or stressors” “The defence mechanisms mediate the individual’s reaction to emotional conflicts and to internal and external stressors” DSM IV 1994

3. Coral Tree July 07 Psychological defences Mature/ high adaptive –Anticipation, affiliation, altruism, humour, self- assertion, self-observation, sublimation, suppression Neurotic/ immature/ mental inhibitions –Avoidant, Schizoid, Dependant, Controlling, Narcissistic borderline/ image-distorting –Denial, projection (projective identification), splitting (devaluing/ idealising),

4. Coral Tree July 07 Psychological defences Rigidity vs flexibility “insight”: a balance of acceptance and denial range of maturity, influenced by anxiety level, mental state, context Working in the zone: make use of/ show respect for/ identify/ challenge Countertransference: awareness of ones own defences/ judgements

5. Coral Tree July 07 Relationship insecurity Relationships with adults & peers marked by instability/ polarity Ambivalent (approach/avoidance) Hypervigilant Rejection sensitivity Poor affect regulation –Autonomic arousal –Numbing/ dissociation –Intense anger “flashbacks” from procedural memory

6. Coral Tree July 07 Relationship insecurity Things that usually work, don’t seem to A self-perpetuating problem The solution: –think relationally –remain empathically engaged –be firm, strong and hopeful –Endure –Notice incremental improvement –Expect setbacks

7. Coral Tree July 07 Questions and discussion