Defensas y resistencias

DEFENSAS
La ansiedad es parte inevitable d ela vida, pero demasiada ansiedad es desabilitante. Una de las capacidades ms cruciales que necesitamos adquirir tempranamente es cmo manejar la ansiedad y sus duros efectos. La presencia de una figura que d respuesta emocional al beb y que pueda digerir sus ansiedades provee los blocks de construccin para el funcionamiento del sistema regulador d ela afectividad

 En la teora freudiana la ansiedad era vista como una instancia intraqusica defensiva que deba ser tratada. Pero los desarrollistas y ambientalistas introdujeron una dimensin necesaria: la ansiedad es un precursor del desarrolloy no slo un conflicto intrapsquico.

 Developmentalists and attachment theorists have since introduced a much-needed developmental dimension. They have contributed to a shift in focus away from an understanding of defences as responses to internal conflict, emphasising instead the origins of defences in the earliest interactions with others.

 Some defences are developmentally necessary if the individual is to survive difficult early experiences. denoting the importance of considering where the patient is coming from (i.e. the notion of deficit) and where he may yet have to reach in terms of his psychic organisation.

 In cases where the house isnt yet built, what may look like an attempt to throw somebody out of the house to project their suffering infantile part into someone else may really be a desperate attempt to find a house anywhere

 Interpreting defences requires that we point out to the patient that we understand how the defences may have helped him to survive and develop even if they now stand in the way of further growth.

 Defences are approached in terms of their socalled costs and benefits,

THE FUNCTIONS OF DEFENCE

Whether we approach defences as attempts to manage intrapsychic or interpersonal conflicts, they always exist to protect us from perceived danger and the ensuing psychic pain. Defences are mobilised against forbidden impulses and painful affective states not just anxiety, even though this is often the underlying subjective experience.

 Defences are a function of the ego. Defences are part of the process rather than the context of mental activity, that is, they are also unconscious. Occasionally we decide that we want to avoid particular thoughts and so implement avoidance strategies quite consciously. For the most part, however, defences are brought into play without any conscious will.

 All defences represent ways in which meaning can be distorted, We have many devices at our disposal that allow us to avoid disturbing ideas, feelings or thoughts.

 We may exclude the feeling or thought from consciousness altogether (e.g. as in repression). We may admit the disturbing feeling or thought but only after it has undergone transformation by being disguised (e.g. as in sublimation). We may consciously admit the feeling or thought but it is detachedfrom its emotional meaning (e.g. as in intellectualisation). We may substitute one feeling or thought for another (e.g. as inreaction formation). We may distort or confuse our perception of ourselves or others thusfundamentally altering our perception of external and internal reality (e.g. as in splitting).

 Defences have often been likened to a kind of psychic skin that allows us to manage the psychic blows that are an inevitable part of life. One of their functions is indeed to maintain psychic equilibrium. Defences can also be restitutive of self-esteem.

TIPOS DE DEFENSAS
Prior to 1926, Freud had conceived of defence as synonymous with repression a kind of pushing away from consciousness of disturbing thoughts or feelings. In 1926, he came to understand repression to be one of many defence mechanisms.

 There are defences that destroy or attack a mental process and leave the patient bereft of his own mental capacities (e.g. attacks on thinking as a defence against understanding something painful) and defences that destroy a mental rep- resentation (e.g. splitting the representation of a significant other reducing them to a part object).

 Defences can be divided according to whether they are characterological or situational. Characterological defences denote relatively constant defensive procedures that occur in most situations These tend to be defences that are so over-used that they become an integral part of the fabric of the personality. Characterological defences can be further subdivided according to their level of psychic organisation, namely, neurotic, borderline or psychotic

 By contrast, a situational defence may arise only in response to a particular context; its use does not dominate the personality. For example, at times of stress we may resort to a particular defensive strategy that would not otherwise be characteristic of our usual way of being.

WORKING WITH DEFENCE

Faced with the experience of anxiety three psychic options are open to us. Each one is associated with a different subjective experience of anxiety and reflects different levels of psychic organisation (see Chapter 4). We can cope with the anxiety by consciously addressing its source and try to resolve it. We can defend against the anxiety. We can break down if the anxiety is overwhelming and defences fail.

Guidelines for working with defences

Identify the patients core pain/anxiety in relation to its trigger. Ask yourself what the patient is capable of managing. Remember that defences have both adaptive and maladaptive functions. Formulate the consequences for the patient of not using defences. Think developmentally: consider the patients level of personalityorganisation (neurotic/borderline/psychotic). Note the flexibility or rigidity of defences and the implications of this fortherapy . Interpret to the patient the why and how of their defensive operations butavoid using jargon.

RESISTENCIA
The term resistance means essentially opposition. It refers to any defensive manoeuvre, as deployed in the psychotherapeutic situa- tion, which impedes the therapeutic work. Resistance may be conscious or unconscious. Whatever its source, the presence of resistance always implies that some kind of danger is impending.

 Working with resistance shares a lot in common with how we approach defences. Resistances can occur at any stage of psychotherapy. Resistances can be obvious as, for example, when the patient arrives late or they can be unobtrusive (Glover, 1955) as when the patient appears compliant but the compliance masks hostility to the process.

 Because resistance occurs in the context of the therapeutic situation it is incumbent on us to acknowledge the reality/external factors that may compound a resistance.

 The first stage of working with resistance requires a formulation of the patients relationship to help, that is, we strive to make sense of what internal object relationship is activated when the patient experi- ences himself as needy and vulnerable in relation to us as the helper.

 This distinction relates to the important considera- tion of whether the resistance results from an internal conflict or a deficit.

Greenson (1967).
He suggests a gradual approach to the interpretation of resistance that distinguishes between the following: The fact that the patient is resisting and how they do it (e.g. lateness, silence). What is being kept at bay (i.e. what affect is the patient trying to protect himself from). Why the patient needs to do so (i.e. what would be the consequences of not doing so).