Why assessing defensive tendencies?
•Understanding pts etiology and pathology formation
•Assessing a person’s defensive tendencies contributes to make psychotherapy as effective as
The person whose behavior manifests defensiveness is generally trying unconsciously to accomplish one or both of following ends：
• the avoidance/management of some powerful, threatening feeling, usually anxiety, but sometimes overwhelming grief or other disorganized emotional experiences
• the maintenance of self-esteem
•Psychoanalytic thinkers assume that we all have preferred defenses that have become integral to
our individual styles of coping
• This preferential and automatic reliance on a particular defense or a set of defenses is a result of a complex interaction among at least four factors：
• one’s constitutional temperament
• the nature of stresses that suffered in early childhood
• the defenses modeled—and sometimes deliberately taught—by parents and significant figures
• the experienced consequences of using particular defense
Overdetermination & The principle of multiple function
Defense vs. coping style
•the same construct
•unconsciously v.s. consciously
•involuntary vs. voluntary
•pathogenic v.s. adaptative
•problem-solving to the internal conflicts & emotions or external stressors
The hierarchy of defense (1) Kernberg(1984):
- Secondary defenses protect the ego from intrapsychic conflicts by the rejection of a drive derivation or its ideational representation, or both, from the conscious ego.
- Primary defenses protect the ego from conflicts by means of dissociation or actively keeping apart contradictory experiences of the self and significant others.
- The defenses we tend to consider more archaic involve the boundary between the self and the outer world, whereas those we consider higher-order processes deal with internal boundaries, such as those between the ego and superego and the id,
- or between the observing and experiencing parts of the ego
•The whole interview process stimulates defenses, giving the clinician the opportunity to see how
the pt copes with the stress of being invited to expose private and painful information to a stranger
Some of specific questions might highlight the defensive functioning
- What do you tend to do when you’re anxious？
- How do you comfort yourself when you’re upset？
- Are there any favorite family stories about you that capture your basic personality？
What kinds of observations or criticisms or complaints do other people tend to make about you？
- How do you find yourself reacting to me？
Possible operations of defenses
•defenses can alter one’s perception of any or all of the following：self, other, idea, or feeling.
They can operate in the realm of cognition(e.g. rationalization), emotion(e.g. reaction formation), behavior(e.g. acting out), or some combination of these (reversal) (Vaillant, 1971)
Defense and Psychodiagnosis
•It is critical to the understanding of psychoanalytic character diagnosis. The major diagnostic categories used by psychodynamics to denote personality types refer implicitly to the persistent operation in an individual of a specific defense or constellation defenses. Thus, a diagnostic label
is a kind of shorthand for a person’s habitual defensive pattern.
Clinical v.s. Research Considerations in Assessment of Defense
•For research purpose, observable behaviors are preferable to those that make use of internal and inferred process
•For clinical purpose, it is more important to know the meaning of a person’s behavior than to describe that behavior accurately the way an external observer would
7 criteria for antisocial PD in DSM-IV
• Acting impulsively
• Displaying overt irritability & aggressiveness
• Failure to conform to social norm
• Showing reckless disregard for safety of self and others
• Behaving irresponsibly
• Lack of remorse
Critical indicators of psychopathic orientation in psychodynamics
•habitual use of some primary defensive operation, such as omnipotent control, projection identification, dissociation, and acting out
The DSM criteria lead themselves to overdiagnosis of psychopathy among people in marginal subgroups, such as adolescent gangs and criminal organizations, and underdiagnosis of it among those succeed in mainstream roles.
•Understanding the internal subjective world of the psychopathy is much more useful therapeutically than locating him or her in an "antisocial" role.
It include the importence of the therapist’s taking an explicitly power-oriented stance with the pt, demonstrating incorruptibility, and making interventions that assume a utilitarian rather than a moral compass in decision making.
The psychodynamic assessment can alert the interviewer to antisocial dynamics long before the behavioral consequences of a psychopathic psychology become evident—an outcome of special importance in the case of this diagnosis
Habitual reliance of defenses and certain characterological tendencies
•Borderline-level personality organization ： splitting, projective identification, and other
Schizoid tendencies：withdraw into fantasy
•Paranoid process：reaction formation, projection
•Psychosomatics and associated alexithymia：regression, conversion, somatization
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等級國防（ 1 ）肯伯格（ 1984年） ：
- 匿名使用者6 年前