Defense Mechanisms and Core Psychotherapy Techniques

Defense mechanisms are mental techniques used by the ego to keep conflicts outside awareness, reduce anxiety, control instinctive urges and unpleasant emotions, and maintain self-esteem, safety, and equilibrium. They protect the person, but excessive use can produce neurotic symptoms.

Acting out is an outburst of previously inhibited emotion or behavior, often through actions rather than words; it is usually considered healthy and therapeutic. A boy harshly criticized by his father responds with a temper tantrum.

Intellectualization uses intellectual processes excessively to avoid emotional expression or experience. A patient with cancer focuses on how interesting it is that more people have the same cancer.

Humor is a mature defense that expresses feelings and thoughts while bringing comfort or release to self and others. A patient jokes that having many conditions is good because it keeps the doctor busy.

Cognitive behavioral therapy is a goal-oriented, systematic approach intended to influence dysfunctional emotions, behaviors, and cognitions. It is an umbrella for techniques grounded in behavioristic learning theory and cognitive psychology, including learning theory and operant conditioning. Symptoms are relieved by changing behavior and thinking patterns.

Most defenses are unconscious; suppression is the exception. Defenses are discrete and dynamic, and they may be adaptive or maladaptive.

Blocking is a temporary interruption in thinking. The vignette clue is an abrupt loss of the train of thought: “What were we talking about?”

Isolation separates an idea from its accompanying emotion. Clues include showing no emotion on seeing a friend’s body or dispassionately describing a father’s death in a road traffic accident.

Regression returns to an earlier stage of immature behavior. The given example is a 66-year-old physician beginning to help a colleague occupy a seat at a routine meeting.

In the stated CBT strategy, sessions occur weekly for as long as 25 weeks. The patient learns to identify distorted, negative thoughts about the self and replace them with positive, self-assuring thoughts.

Freud founded psychoanalysis. His listed contributions include defense mechanisms, free association, libido, repression, transference, regression, sublimation, the id, ego, and superego, and the Oedipus complex.

Denial avoids awareness of a painful part of reality. A patient with cancer insists that the diagnosis must be wrong.

Repression unconsciously withholds an idea or feeling from awareness. The clue is unconscious forgetting, such as not remembering a car accident from two years earlier.

Somatization converts psychic distress into bodily symptoms. In the example, a woman suddenly becomes blind after hearing bad news.

Listed uses of CBT are mild to moderate depression, somatoform disorders, eating disorders, and phobia. The associated concepts listed are precontemplation, contemplation, and consolidation.

• Id: drives and instincts present at birth.
• Ego: develops after birth, works on the reality principle, and handles defenses, judgment, relations with reality, and object relationships.
• Superego: conscience formed during the latency period.

Displacement shifts an emotion or drive to a similar but more tolerable object. After fighting with a supervisor, a person kicks the dog.

Suppression is conscious forgetting and is the only conscious defense. One example is Peter consciously moving past a colleague’s insult, forgiving the colleague, and becoming friends.

Splitting divides external objects into all-good or all-bad categories. “All car dealers are cheaters” illustrates the all-bad pattern.

Flooding is a type of behavioral therapy. Systematic desensitization is used for phobia.

Introjection takes features of the external world into the self. A secretary begins dressing like her supervisor.

Rationalization supplies reasonable-sounding explanations for unacceptable feelings, attitudes, beliefs, or behavior. Examples are saying a failed entrance examination was not worth passing or reframing job loss as welcome exercise time. If the avoiding nurse merely made excuses, that would be rationalization rather than projection.

Sublimation is identified as the most mature defense. It redirects an instinct’s unacceptable aim or object into an acceptable one while achieving impulse gratification. A boy who enjoys ripping things becomes a surgeon.

Projection attributes one’s own wishes, thoughts, or feelings to someone else. Examples include insisting another person acted intentionally and a nurse who avoids a patient with late-stage cancer while claiming that the patient wants to be left alone.

Reaction formation denies an unacceptable feeling or transforms an unacceptable impulse into its opposite, producing opposite attitudes, behavior, or character traits. An angry person may compliment a friend’s shirt; after fighting with a coworker, a frustrated person may smile at the supervisor.

Undoing tries to reverse an unacceptable thought or past action through a contrary present action. Examples include insulting someone and immediately offering praise; quitting smoking and drinking, then urging friends to do likewise; and, after smoking-related lung cancer, buying nutrition books and stopping smoking.