While surfing the internet, I stumbled upon this academic article about defense mechanisms.
It’s a fascinating read if you’re into ego psychology. They do make it out to be a somewhat exact science, which stretches my credulity.
But I love psychology, I like this journal overall, and I thought it was a very good article until I was flabbergasted by an excerpt they saw fit to include from a “therapy” session.
Session Excerpt
Here’s an excerpt of the session from the article. I think it could be felt as invalidating and retraumatizing by a client who was already traumatized:
Most of the session was characterized by the patient complaining about several aspects of his life, including the therapy, in which he had experienced ambivalence, detachment and frustration.
When the therapist tried to interpret these feelings as defensive responses to the experience of temporary unavailability of significant people, the patient denied the interpretation and perceived the therapist as manipulative.
Despite (the) therapist’s interpretations of his opposition, silence and emotional distancing as reactions to feeling frustrated by not getting what he wants when he wants, the patient rejected them and became even more oppositional.
Toward the end of the session, after many therapist’s attempts of interpreting patient’s maladaptive pattern, the patient could finally reflect upon it and became more collaborative.
However, his reflections were influenced by generalization, detachment and ambivalence.
The patient described himself as stuck in silence, his inability to talk about his feelings, to see things in a different way. At this point the patient was able to let the therapist help him and get involved in a shared exploration of his fears, needs and desires.
He reflected on his difficulty in listening to his girlfriend’s trouble but somehow justified it as a need of physical connection.
However, when the therapist made further interpretations of the patient’s fantasy of emotional fusion, the patient seemed to reactivate the projective pattern, which was promptly interrupted by the therapist.
This allowed the patient to keep reflecting in an ambiguous manner instead of complaining and activating all sorts of immature defense mechanisms.
Psychodynamic Therapists Can Essentially “Attack” Defenses
So this “therapist” was “interpreting” the “patient’s” “defensive” and “maladaptive” patterns, and the “patient” displayed “opposition” to the “interpretations” of their defenses.
It made me laugh and recoil at the same time. Why would you think this is a way to help somebody?
The patient may have felt so awful afterward. Talk about pathologizing somebody who’s probably already been traumatized.
The article portrayed the session as:
A poor therapist kept explaining to this patient (in pathological terminology) exactly what the patient was doing wrong at every single turn in their emotional life.
And then the “patient” was not grateful.
Instead, that difficult patient kept doubling down and justifying their feelings.
That client needed understanding, validation, and support. Not invalidation / re-traumatization by a “more authoritative” / more powerful other. How destabilizing that may have been.
This is an extreme example, but this power-differential / disrespect / pathologization dynamic does creep into a lot of therapists’ offices based on my personal experience – but not all of them thankfully.
A person with CPTSD has experienced invalidation and has been made out to be the problem, by a more powerful, more authoritative other enough times already.
People need respect, validation, support, and kindness, especially when they’re hurting and trying to heal. I think the lack of those things is a carryover from the medical model of disease.
The Medical Model of Disease
Psychology was originally founded upon the medical model of disease.
Freud was a physician, as were all his immediate successors. I believe Freud was a genius, probably a wonderful man, and we owe him a great debt of gratitude. And he thought in terms of medicine & pathology.
However, the medical model of disease isn’t always a great framework for promoting respect and kindness toward people’s troubles. Labeling a suffering person’s thoughts, feelings, and behaviors as disordered or pathological can be unhelpful at best. For obvious reasons (see above case study). Even if the presentation is problematic for the client.
Especially for relational trauma survivors, the main thing they are struggling with is toxic shame. So people helping them need to be cognizant of this and have effective ways to alleviate it.
Left Defenseless?
And even if the therapist in the example was 100% spot on (which is always questionable no matter how “well-analyzed” the therapist is), defenses are a defense against something else – unbearable memories, realizations, feelings (shame, terror, etc.).
So if the therapist did successfully break through all his patient’s defenses by roughly confronting them – what would that patient be left with? Everything they’re defending against – shame, fear, etc. A giant emotional flashback. So even if this therapist had been “successful”, he may have hurt his client.
You can’t just eliminate a traumatized person’s defenses; that leaves them defenseless. You have to dissolve the underlying shame and discharge the built up fear, complete the grief from all the losses.
Most Therapists Don’t Intend to Harm
If you’ve ever felt invalidated, pathologized, or even attacked by a therapist, it can be a horrible and re-traumatizing experience.
To give therapists the benefit of the doubt, and maybe you some peace of mind … I don’t think they meant harm. I think it’s what they’ve been taught – that if you can break through a patient’s defenses, they’ll be better. I disagree.
They think they’re attacking just your defenses – they know the awesome real you is underneath, and they think if they can undermine your defenses, the authentic you will be free to emerge. And if you’re ready, this can work beautifully, actually.
But if the “what’s wrong with you” model is used too … exclusively … it can feel like they are attacking you. They kind of are; they’re questioning parts of your ego anyway. Fair enough; we all have blind spots. But … this strategy does not address the reason the defenses are necessary in the first place (the underlying shame, fear, guilt).
The Trauma-Informed Movement
Thank God for the trauma-informed movement. Gentle healing and growth, building upon the strengths we already have.
If somebody has defenses, it’s because they needed them at some point, probably for survival. Only when survivors realize that we’re not in danger anymore and that we’re not bad, defective, guilty, or shameful, will we drop our “defenses”. We won’t need them.
When we realize we are now safe. That’s the essence of the trauma-informed movement.
To see survivors as having a normal aftermath to an abnormal (or traumatizing) experience. To see them as fundamentally whole, and to strengthen them by building on their strengths.
To enable them to feel safe by validating, supporting, and really just loving them.
Jim McGee
Trauma Informed Coach
NARM-Informed Professional
I bring a blend of personal experience and professional expertise to my work. Having navigated & continuing to navigate my own journey of recovery from CPTSD, I now serve as a puzzle master & voice of experience for fellow travelers on their own path to healing.
Discovery Coaching Session
30 min – Free – Learn How CPTSD is Healed
Free to those who want to explore the possibility of healing and post-traumatic growth. This is a time for us to assess if our energies align for your healing journey. We’ll explore your current situation and discuss how we might get you to your healing destination. Explore relational support, state-of-the-art strategies for healing CPTSD permanently, and a safe environment for healing.