acquainting patients with defenses

Today we will talk about the all important phase of defense work. This is often given short shrift, with the patient continuing to employ defenses well into treatment. We discuss the 4 phases of defense work, from identification and clarification of function to the cost of these defenses and the ways in which they create and perpetuate suffering. Only once the patient is well acquainted with these defenses are they in a position to choose whether to hold onto them or let them go in favor of an honest look at their feelings.

[@rod4530]

Such a good video. Really helpful - thank you.

[@saras.2173]

Many times in your videos you say something along the lines of…the therapist’s job is to help the patient see how their defense mechanisms are actually causing or perpetuating their symptoms. My question is, how can I explain this to the patient if I don’t understand it myself? I need help understanding the exact mechanism by which this phenomenon occurs, with lots of examples. Thank you.

[@patriciacoughlinphd1852]

This is essential knowledge for all therapists. I you don't have this knowledge, you need to read, go to seminars and get training and supervision so that you can understand your patients and learn how to intervene effectively.

[@toslso]

So great to hear more on this topic! Do you think you can do a video with more about the defense work around acting out with things like actual physical self-harm? Thanks

[@patriciacoughlinphd1852]

Will do.

[@SylviabombsmithUjhy75bd34]

Brilliant.

[@patriciacoughlinphd1852]

So glad you find it helpful.

[@andreea140794]

How would one work with a person who is paralysed from the neck down, who cannot feel anything in their body (literally).

[@Pedro-ew1dj]

Thanks Patricia for the video 👏! When I listen to those steps you mention, I am constantly amazed by Davanloo's ability to operationalize the psychodynamic technique (which makes it much more similar to cognitive behavioral therapy or integrative therapy in my opinion). My question is when patients identify their defenses, cost and function, but continue using them since they are automatic ways of responding (or habits)... By definition, defenses are unconscious and operate immediately when threatening feelings and anxiety appear... .so they can understand and modify them in the session but then activate them again outside the session. It is a definitive change to these defenses possible? I believe that they can be made more flexible but difficult to completely eradicate... The truth is that I increasingly doubt that the personality structure or deeply rooted traits can be changed. I think that people change but very gradually and making some traits more flexible but they do not change diametrically. Thank you for your comments!

[@patriciacoughlinphd1852]

We have a great deal of evidence - both on videotape and in empirical investigations (check out Allan Abbass's website for an expanding list of studies) - that we can achieve deep and lasting character change with ISTDP. Once the patient relinquishes defenses in favor of experiencing his true feelings, the unconscious opens, revealing the source of the conflicts responsible for the patient's suffering. The past becomes present and can be resolved at the source. Healing and freedom result. Returning to defensive avoidance makes no sense in such a situation. As "the Masochistic Artist" said, at 5 year follow up, "I vaguely remember how I used to turn my anger back on myself and allow others to use and abuse me, but it's inconceivable that I would ever do that again." There are countless examples of this in all my books. Have a look!

[@NanePirumyan-x5f]

Thank you for your work. I have a question. Two therapiests told me that I am childish (I am 30 years old). Is it possible to get ride of my childish character with a help of ISTDP? Does it mean that the only thing which can help me is to feel my childish feelings und cry? Thanks again!

[@patriciacoughlinphd1852]

I can't say anything without seeing and evaluating a. patient myself. Nor do I have any way of knowing what these therapists meant by saying you are childish. That said, patients certainly grow and increase their capacity for mature and adaptive functioning in ISTDP;

[@NanePirumyan-x5f]

@@patriciacoughlinphd1852 Thank you. They mean, I react and feel like child (Like I am not an adult). Is it possible to do ISTDP online session? Or it has to be always in present? I mean therapy session with you online from Germany? Thanks!

[@patriciacoughlinphd1852]

@@NanePirumyan-x5f contact me directly at [e-mail]

[@NanePirumyan-x5f]

@@patriciacoughlinphd1852 thank you. I will write you.

[@kevinnaidu3713]

I'm wondering if this pertains to high functioning autistic clients who often use masking as a way to defend themselves from showing there true autistic self. They would smile and laugh in order to appear socially acceptable. Do we help them see this defense?

[@patriciacoughlinphd1852]

I am. not sure what you mean by masking. Generic advice is rarely helpful. I would have to know a whole lot more about the patient before being able to give any feedback.

[@hediyehh5498]

❤❤

[@frankyfourfingers1382]

I have a defence where, for example, I tell the psychologist about something troubling, and I'll laugh about it. I'll laugh about the insanity of the situation, where it's not REALLY funny at all. I do it a lot. I realize it's a defence, and the (ISTDP trained) psychologist points it out, but that's as far as it gets. I'm stuck.

[@patriciacoughlinphd1852]

Now that you see how the laughing is dishonest and covers up your true feelings you have a choice- to continue to laugh it off or have an honest look at your true feelings.

[@frankyfourfingers1382]

@@patriciacoughlinphd1852 Right. That's what I'm saying, I don't know how to go about doing that.

[@patriciacoughlinphd1852]

@@frankyfourfingers1382 It's a clear choice - to feel or avoid. I would suggest bringing this up with your therapist.