Our series on defence mechanisms in counselling and psychotherapy continues with this post on the defence of dissociation.
Compared to some of the other defences, dissociation is less well known amongst the general public, despite it being very common (at least in mild forms.) We dissociate a little bit when we zone out, and become mentally absent from the situation in which we are physically present. The association between our mental presence and physical presence is disrupted - hence dissociation. More severe dissociation can lead to actual physical numbness, inability to feel one's body. As emotional and mental life become seperated, in dissociation we may also not be able to feel our emotions. We may feel unreal, or quite distance from a situation unfolding around us. Another variant of this is de-realisation, in which the situation around us begins to feel unreal, like a dream or a movie.
Like other defences, we use dissociation to distance ourselves from uncomfortable emotions. Often people who dissociate are aware of a link between their anxiety building up, and beginning to dissociate. Possibly the strongest form of dissociation is the controversial diagnosis of dissociative identity disorder, in which parts of one's identity become separated off from other parts. This was once called multiple identity disorder, which would be the topic of a whole other post.
When the client begins to dissociate in a psychotherapy or counselling session it is usually a sign that anxiety has become too intense to tolerate in other ways. Hopefully your psychotherapist or counsellor will notice this, or, it may be helpful to tell your therapist if you notice that you're beginning to dissociate. Most clinicians know basic grounding exercises that they may talk you through at this point, to help you reorient yourself to being aware of your body in the present moment, or perhaps to re-orient yourself to the external reality of the room in which you're sitting at that time, by noticing things such as the walls or the furniture around you. For most people this quickly helps reduce the dissociation, and is a useful practical skill to learn to deal with dissociation in one's daily life.
This is part of a series of posts on defence mechanisms in psychotherapy and counselling. Today we'll tackle the defence mechanism of intellectualisation.
Intellectualisation is considered one of the more mature or advanced defence mechanisms, but like the other defence mechanisms, it can still sometimes become unhealthy. When we intellectualise, we rely exclusively on reason, thereby distancing ourselves from or entirely blocking out disturbing feelings or anxiety. It is not merely the use of the intellect, but a "flight into reason", away from pain.
Sometimes the pain that we might avoid through intellectualisation is associated with a difficult decision, in which case the intellectualisation becomes a repeated analysis of the logical aspects of the difficult choice. At times this may be helpful, even of survival value, as we may need to remain "cool headed" and may not always benefit from deciding out of our feelings. However, people who intellectualise a lot tend to not only not decide out of their feelings, but tend to ignore the feelings altogether. This can cause problems. It can cause us to ignore our intuition, to ignore an opportunity to consider what this feeling might be telling us about the most beneficial course of action, can cause us to ignore factoring our happiness (an emotion!) into the decision, and by deactivation our emotional response can reduce our motivation to act on our decision. I read a book (an unfortunately cannot remember which book!) that talked about a true case of a judge who due to a very specific form of brain damage was unable to feel emotions. This judge ended up retiring himself, because he believed that without the input of his emotions his judgement was impaired.
Apart from decision making, intellectualisation can cause us other problems. People who overly rely on intellectualisation can be boring, even if they are smart and knowledgeable. This is because part of what we respond to in other people is their emotions. An interesting idea stripped of emotions often doesn't stay interesting. Related to this, people who intellectualise a lot may become so wedded to analysis that they forget how to play. Without playfulness, our relationships tend to suffer. Humour (considered an even more advanced or mature defence mechanism than intellectualisation) may be the antidote for the dryness of rampant intellectualisation.
Psychotherapists and counsellors should, by virtue of their training, be able to spot intellectualisation in their clients, and work with it constructively. Often, for me this means pointing out to a client that when I asked them what they felt, they told me what they thought, and then inviting them to consider the feeling. Sometimes that may mean exploring the cost of excessive intellectualisation, in terms of loss of intimacy in relationships, or the general loss of aliveness that comes from turning off feelings.
At times however, in the psychotherapy or counselling process, intellectualisation can be helpful. Part of what therapists offer to clients to help deal with emotional overwhelm, may be a set of ideas that give them a safe point to step back into and from which to view the emotional chaos. Sometimes intentionally changing gears into the intellect provides the necessary respite, and helps things to feel safely understandable, so that the client can once again return to the necessary therapeutic task of learning to bear their feelings.
Continuing this series of posts on defence mechanisms in counselling and psychotherapy, today we'll look at the manic defence. For more information on defence mechanisms, check out the first post in this series.
Very broadly, the manic defence is an attempt to do things or think things quickly, to create a sense of busyness that shuts out unpleasant feelings. More specifically, often the feelings that are being shut out are feelings of powerlessness or hoplessness, which are often being shut out with the contradictory feelings of euphoria, goal oriented activity, and control or mastery. Like other defence mechanisms, there really is an intelligence to this, it is very hard to feel hopeless whilst energetically pursuing a meaningful goal. It works. In my opinion the manic defence is also one of the most widespread defences, at least in Western culture where being busy and constantly doing are a virtue.
For many people powerlessness and hopelessness in the extreme can manifest as depression, including lack of energy and pervasive sadness or numbness. The manic defence is often thought of as a defence against depression, though many consider the manic defence to be different from bipolar - or what was once called manic-depression.
In the psychotherapy or counselling process I most often notice the manic defence when a client talks a lot. In particular, when the client's talk is tangential, and is a response to us beginning to talk about painful feelings. When appropriate, I might notice this with a client, by saying something like: "Do you notice that just now as painful feelings began to rise up, you began to get anxious, and you distanced yourself from these feelings by talking fast and changing the topic?" In such a situation, with a client who is ready and willing to work on their defence mechanisms, it may be an act of kindness for the psychotherapist to actually interrupt their client's torrent of words and to help them see their manic defence in action. Thought it may be painful in the short term, experiencing painful feelings rather than shutting them down through mania may at times be a better long term choice. The cost of overusing the manic defence can be exhaustion, spiralling anxiety (because the problems are not dealt with), and difficulty connecting emotionally with others.
For those who are actively working with their own defences of mania and busyness, mindfulness can be an effective practice. Usually this will start with moments of mindfulness in the psychotherapy room, such as the above example when the psychotherapist helps the client to be mindful of their reaction to painful emotions in the moment. Some may take up mindfulness practice in their daily life. By just noticing and not amplifying the flow of thoughts, over time the thoughts slow down, and the usual experience is relief at the lifting of a burden that couldn't even be fully recognised until it lifted. Mindfulness practices that involve being still (rather than for instance walking mindfulness practice) have the advantage of creating physical as well as mental stillness, which further helps with the manic defence.
An interesting Australian article here discusses use of the manic defence by mental health professionals. An example given in the article is the use of antidepressants by GPs and psychiatrists to treat depression. Here the response is to do something, to prescribe something that stimulates rather than to deal with the painful feeling directly. Though I cannot personally comment on prescribing, and don't discourage use of antidepressants, this article is thought provoking. Amongst psychologists, psychotherapists, and counsellors, I see the manic defence at work at times, when the clinician out of a sense of helplessness or anxiety throws behavioural tasks or exercise at a client. Once again, though behavioural interventions aren't bad (I use lots of them myself), when they are being given to clients as a reaction to the clinicians own anxiety, I believe that the client on some level can feel the emotional disconnect, and is affected by it.
For an introduction to defence mechanisms in counselling and psychotherapy, please read earlier posts in this series. If you're familiar with these ideas, or have already read earlier posts, please read this post about the defence mechanism of acting out.
Compared to some of the more subtle or slippery defence mechanisms that we've discussed, such as projection, acting out is generally fairly easy to recognise. In fact, usually when people act out, it is with fairly extreme behaviours that are difficult not to notice! Acting out involves behaving in an extreme way as an alternative to feeling and tolerating an uncomfortable emotion.
Common examples include people who act out by cutting themselves, to avoid overwhelming feelings, or to avoid a feeling of numbness. (People also cut for other reasons, but acting out is commonly part of the dynamics of cutting.) Another example is that of a person who hits their partner, rather than feel and tolerate anger, powerlessness, or shame.
Acting out is a defence mechanism that a counsellor or psychotherapist will often, in one way or another, help their clients to change, simply because acting out can cause a lot of suffering both to the client and to those around them.
As with other defence mechanisms that are easily noticed and potentially destructive, acting out can bring with it a lot of shame. The normally polite person who acted out by drunk dialing their boss and abusing them will feel mortified the next day, and will probably find it very difficult to get help from a therapist. It is important that the therapist does not avoid talking about the destructive behaviour (because it really is a problem that needs to be dealt with), but it is also important that the therapist conveys a lack of judgement or condemnation.
Given that most of us at times resort to the defence of acting out, and given that often the acting out will be something we later regret, what helps? One of the most common things that helps with acting out is learning to use words rather than actions to express our feelings. This may sound simple, but often it's not.
To use words to express our feelings we need to first be able to identify what we're feeling. Learning to identify what we are feeling can be difficult. It may help to have a therapist who can express what we might be feeling, so that we can decide if that fits or not, and we can learn the language to fit the emotion from how the therapist has been talking to us.
Perhaps we know what we're feeling, but don't feel confident about expressing it. A psychotherapist or a counsellor may help with this by helping us to find clear and assertive language, or to deal with the fear of how others might respond to our expression of feeling.
So, to summarise the above, therapists can help us with acting out by helping us to use words rather than actions to express ourselves. However, this may not be the most important approach for everyone. Some people know what they're feeling, and how to find words to express this, but when under stress find it difficult to avoid acting out anyway. Such people may find a DBT program helpful, particularly skills such as mindfulness that help regulate impulsivity and the intensity of the emotion that is at risk of being acted out.
Through mindfulness practice we let go of the impulse to judge or analyse or act on thoughts and feelings. We do this in mindfulness each moment, when we notice our distracting thoughts or feelings, and bring our attention back to whatever we're focusing on, whether it be our breath, body sensations, a view out the window, or a piece of music. Mindfulness has been shown to be effective in reducing the impulsivity even of violent and impulsive offenders, so it clearly really does work.
Not only can mindfulness help us to not impulsively act out an overwhelming feeling, but we also find that through accepting rather than judging our emotions, we begin to feel soothed and the painful emotion reduces in intensity. There are many styles of psychotherapy and counselling that integrate mindfulness into the therapeutic process, including DBT, ACT, and MBCBT.
Some people seem to fear that through learning to regulate their emotions rather than act them out, they will lose the dramatic or creative aspects of their personality that they value. My experience is the opposite. I have found that through doing this personal work people boost their creative or dramatic potential by being able to add a degree of measured skillfulness and control to the spontaneity that they so value.
So, if you're thinking about changing your habit of acting out, you have everything to gain, and nothing to lose. That said, you may need to learn to assert yourself more, because it is possible that your habit of acting out developed because that's what worked to get people to understand that you needed help.
To understand more generally about the concept of defence mechanisms, and how they relate to psychotherapy and counselling, please read prior posts in this series. To learn more about the defence of this post: sexualisation, please read on.
When we use the defence of sexualisation we imbue something (or someone) with sexual significance in order to avoid our anxieties around feelings such as aggression, dependence, or loss. Like other defence mechanisms, there is something remarkable about our capacity to do this. We not only avoid experiencing something painful, but through the pleasure we receive through the sexual association, we may actually be able to make that experience pleasurable. In general, a psychotherapist or counsellor will only confront a client with their defence if it is hurting them. This seems worth pointing out given our propensity to make judgements around sexuality. Sexualisation isn't bad, and is not something to be ashamed about, but sometimes it gets in the way of living a fulfilling life.
To clear up another possible misconception, the defence of sexualisation is quite a different concept from the concern about people (usually children or women) becoming sexualised. According to Duchinsky this different and later use of the term sexualisation developed in the USA in the 80s, to describe a maladaptive form of socialisation which causes a premature entry by the child into adult forms of sexual subjectivity and desire. It seems likely that many of those who have been prematurely sexualised in this later sense of the word will then resort to the use of sexualisation as a defence mechanism, but they are different ideas.
To bring this out of the heady realm of theory, it might be useful to give a couple of common examples of the defence mechanism of sexualisation. Because men are often taught that we must be independent, many of us feel uncomfortable with dependence. But, inescapably, being social animals, we are dependent on others for social connection. When men who are uncomfortable with their need for dependence feel lonely or disconnected they may sexualise this threatening sign of dependence. Instead of seeking out intimate emotional connection, they may go out on the town looking to "get laid" and having the sort of sex that leaves them feeling more empty and alone than ever. (This pattern is not restricted to men, but seems more common in men due to masculine socialisation to be independent.) In extreme form this can result in men (or women) seeking psychotherapy or counselling for sexual addiction or other sexual problems that are really problems with emotional intimacy.
A more common example of the defence of sexualisation amongst women can arise in women who have been taught in one way or another that women are weak and men are powerful. Such women, being afraid of powerful or aggressive men, may sexualise this fear to the point where they instead feel attracted to powerful or aggressive men. Another side effect of this is feeling understandably envious of the power that men are perceived to (and may actually) have. This form of sexualisation is actually the basis of Freud's much maligned and misunderstood concept of penis envy, which (depending on how you interpret Freud) can be seen as a sympathetic and understanding view of the terrible impact on women of patriarchy. Women (or less frequently men) who sexualise in this way often come to psychotherapy or counselling having had a string of very painful relationships with men.
Most of us find talking about sex uncomfortable, perhaps especially if we're talking about a difficulty that relates to our experience of sex and desire. This means that often in therapy I've noticed that clients talk about everything other than sex. Therapists may be hesitant to ask about sex, out of fear of this being interpreted as dirty or seductive or leading by their clients. On the other hand, because of many of our shyness about discussing sex, if a therapist doesn't ask, often a client won't talk about sex. It's difficult. In couple's therapy, talking about sex can be particularly complicated, as sometimes the sexual topic that one couple feels they need to bring up, is the source of great shame for the other. There is no easy fix for this, but having a therapist who feels comfortable talking about sex, does help.
So far in this series of posts on defence mechanisms we've covered the defence mechanisms of withdrawal and sublimation, and we've talked a little bit about how this relates to the counselling or psychotherapy process. For background, read prior posts. Otherwise, please read on for today's post on the defence mechanism of projection.
In popular culture in the West today, most of us have a basic understanding of the concept of projection. When faced with an impulse within ourselves that we see as unacceptable, we may project it out on to the other. This allows us to perceive the other as having that impulse, and thereby relieves ourselves of the conflict we feel over having an unacceptable impulse.
Whereas the defence of withdrawal, depending on severity, may range from unhealthy to fairly healthy, and sublimation is generally a healthy defence mechanism, projection is generally understood as a somewhat or very unhealthy defence mechanism. Projection has the capacity to significantly distort our view of reality, and our capacity to relate to others. Many counsellors or psychotherapists will try to help their clients to project less, and sometimes to instead adopt more healthy defence mechanisms. An example of this is someone who has become familiar with their tendency to project, and is able to reflectively question the truth or falsehood of their projection based on the facts of the present situation. This would be an example of replacing the defence of projection with the generally more healthy defence of intellectualisation.
Some defences are used heavily by particular personality types. Projection is a good example of this. People with paranoid personality styles frequently project, in particular they project their anger and sense of judgement or hostility on to others. The paranoid person's tendency to vigilantly scan for any sign of untrustworthiness in others, and tendency to interpret facts in line with their projections, can make them very hard to establish intimate and trusting relationships with. On the other hand, a paranoid person is so sensitive and vigilant to signs of untrustworthiness in the other, that they can be excellent when this is an asset, such as in detective work or other jobs involving detecting fraud.
Another example of projection at work is in the case of bullying, in which the bully projects their own feared sense of vulnerability onto another, and then persecutes that other person. It can be useful for the bully and the bullied alike to understand what is being projected, and to not get tricked into missing the strength of the person being bullied, and the vulnerability of the bully.
As a psychotherapist, I often notice my clients projecting things on to me. (Though it is important to remind myself that often there is a grain of truth in a projection, so that I don't disown my own imperfections!) Usually, a client who projects something on to me will also project that same thing on to others, and that is usually part of the cause of the problem for which they sought therapy. Depending on the situation as a therapist I might help my client to see the inaccuracy of their projection, or, I might instead help my client to explore the full extent of this projection that might be harder for them to learn about in another context outside of the therapy room.
It is not uncommon for clients in therapy to project boredom, judgement, criticism, or anger on to their therapists. By naming these perceptions to a therapist who is confident in working with projections, you may be able to significantly benefit your own therapeutic work. Sometimes people also project positive aspects of themselves such as generosity and competence on to others, because it may be disturbing to recognise these qualities in ourselves if we have a strong self image to the contrary. Though projecting our positive qualities on to others may not seem as problematic as projecting our negative qualities, it may have a negative impact on our self-esteem.
Welcome to my series of posts on the concept of defence mechanisms, and on how this concept can help us to understand ourselves in psychotherapy and counselling. If you haven't read my prior post on defence mechanisms, you may find it helpful to read it now as an introduction, then return to read this post.
In this post today we turn our attention to the defence mechanism of sublimation. We sublimate when we transform a socially unacceptable urge into an urge that is beneficial and acceptable to the community. An example is the religious tradition of celibacy, in which erotic urges or energy are transformed into spiritual and/or creative pursuits. When this works well, the conflict between the erotic urge and communal needs is circumvented, and the individual who is sublimating their sexual desire is not left frustrated, but instead experiences satisfaction via the creative or spiritual work that they accomplish. When this process of sublimation is working poorly, we see incidents such as the terrible phenomenon of sexual abuse being committed by catholic (and other) clergy. (Having said this, I'm sure these incidents of sexual abuse by clergy involves many other psychological processes, so please forgive the simplification.)
Another example of sublimation may be the artist's relationship with the muse, in which the erotic energy towards the muse (a real or imaginary figure) fuels works of great creativity. It's worth noting that although psychoanalytic thought gets a lot of flack these days, at times seeming bizarre for it's reducing our ideas of life into strange contorted expressions of craving for sex, this is a misrepresentation of psychoanalytic and psychotherapeutic thinking. The word erotic derives from eros, which is intimate or romantic love (as opposed to selfless love.) Psychotherapy understands the erotic as much wider and more important than mere sex, the erotic is an energy that creates intimacy, sex, romance, and a great deal of our passion and energy for life.
The goal of psychoanalytic psychotherapy is not to dismantle all of a person's defences, but to help a person to graduate to using defences that serve them better. Healthy sublimation is regarded as one of the most mature and worthwhile defences. When other conflicts and less helpful defences are clearer out of the way, through psychotherapy or counselling a creative person may be able to clear their creative block, and free up more energy than ever before for satisfying creative work. A spiritual person whose sublimation is not serving them well, may be able to renegotiate their relationship with sexuality through therapy, hopefully with the outcome of feeling less frustrated and more connected to their spiritual side.
The concept of defence mechanisms is one of the oldest psychoanalytic concepts. LIke other psychological concepts, defence mechanisms have to an extent reached into popular consciousness and understanding. For instance, we have an understanding that denial is a way of warding off knowledge that seems unbearable.
Like many psychoanalytic concepts, defence mechanisms are provocative. Defence mechanisms are not the tamer idea of coping strategies. Defences are a matter of life and death. The client sits securely (or insecurely) behind their defences, their only safeguard against a therapist who is waging an offensive war aimed to bring reality crashing in on them (all for their own good, of course!). It may be evocative, and may capture the imagination, but that that's not the way therapy is. Or perhaps ever was.
My recent study of intensive short term dynamic psychotherapy (ISTDP) has made me look again at the currently neglected (even amongst psychoanalytic psychotherapists) idea of defence mechanisms. Beginning to incorporate ISTDP into my practice has made me much more ready to point out my client's defence mechanisms to them, and to help them understand the cost of using those defences. This series of posts will try to capture the lived experience of using some of the more common defence mechanisms, as well as the costs that this can have. We'll start with the defence of withdrawal.
Touch a sea anemone, and you'll notice the tentacles instantly shoot backwards... And then over time watch as the anemone cautiously begins to unfurl it's tentacles back out into the world. Some people act like this. Dreading overstimulating emotional contact, they withdraw either emotionally or physically to preserve their sensitive inner world from the perceived threat of devastation. This may be a conscious choice, or it may still be a choice but one that is made at quite an unconscious level. Withdrawal may be slight, such as taking a moment to look away during a difficult conversation, in order to marshal one's thoughts, or it may be extreme and prolonged such as the case of someone who lives mainly in their own fantasy world rather than through real interactions with other human beings.
One of the advantages of using withdrawal as a defence mechanism is that unlike many other defences, it may leave our view of reality relatively undistorted (compared to, for instance, a defence such as projection.) On the down side, by overusing the defence of withdrawal we may lose opportunities to learn better how to overcome difficult interpersonal challenges, and we may help create dynamics in which others such as our partner, may have to chase us in our withdrawal in order to maintain a relationship.
Counselling and therapy isn't about dismantling our capacity to withdraw (or use any other defence mechanisms), but to help us to know what we are doing by using them, and to at times make choice to not defend ourselves, or to use different defences when that would help us to live happier lives.
Though it's not developing at the break-neck speed of the physical or biological sciences, research is developing our understanding of what helps relationships to work, and why. As a couple's counsellor or therapist I was reading the research summarised below to help me to help the couples I work with, though you may find that you can directly apply these findings to your own relationship and get some benefits. Research summarised in psychology today affirms that couple's therapy does work, and looks at first factors that give the most benefit.
Though this is a list for couples therapists, none of it is anything that you can't improve on your own. On the other hand, if you would like a helping hand with this, please get in touch with us!
Leaving or needing to leave a relationship is a frequent reason for people to seek psychotherapy or counselling. For some people the process of ending a relationship, though painful, is relatively straightforward, and certainly does not require therapy. However for others, the process is agonising, protracted, and can even be disabling in terms of a person's ability to work, care for themselves, or maintain other important relationships.
Recent research suggests that addictive processes may be involved, for those who struggle severely with ending relationships. Particularly early on, relationships can trigger the dopamine system in our brain - that's the pleasure center that makes us feel really good. Drugs like cocaine similarly stimulate the dopamine center of our brains. The researchers of this study have wondered if the task of leaving a relationship or "falling out of love", for some, might be the equivalent of an addict giving up cocaine.
While I don't know enough about neuroscience to critique the research, certainly subjective addiction related feelings of craving, difficulty with self soothing, and obsessive focus on the substance (or person) of addiction rings true. If leaving an addictive relationship is like giving up a drug habit, then perhaps the following common features of counselling or therapy for addictions might be helpful for some:
Motivational interviewing: The therapist does not take sides about the need to leave or stay in the relationship (in contrast to friends and family who probably have strongly expressed opinions), but helps the client to come to their own decision based on weighing up the alternatives in a personal way.
Relapse prevention: Going back to an addictive relationship is common. Having a relapse prevention plan may help by identifying triggers, such as loneliness or comparisons with others who are in relationships, and making practical plans for coping with these feelings.
A supportive therapeutic relationship: Just as addiction is often isolating, and accompanied by immense shame, sometimes people feel ashamed of their difficulty leaving a relationship, and may have become isolated from supportive friends. A warm and non-judgmental therapeutic relationship can form a regular stable base in a person's life, from which they can make the courageous changes they wish to make.