Working with the Defenses

Most people are reluctant about public speaking and I am no exception. Many feelings are stirred up. There is performance anxiety, fear of shame and humiliation, fear of exposure, exhibitionism, and rivalry with others. I was aware of a mixture of all this, when I was asked to give a talk about working with the defences.

Then it started. Quite a few of my patients worked in and around the psychotherapy/ psychoanalytic world, or had friends who did. The flyers started to arrive. A ripple started to go around my practice. Some people were quite direct.

“I want to come. You must be going to talk about me.”

“I wouldn’t want to go because you might be disappointing, not clever enough”

“I want to come because I have to know what you are saying”

“It makes me feel weird”

Someone else started expressing all sorts of rivalry with the audience and with the other presenters. She wanted her therapist to be the best, needing to maintain an idealisation.

Others were indirect.

There were various dreams with themes about toileting in public, with feelings of shame, humiliation and exposure. Someone started talking about a colleague presenting a paper which exposed the presenter’s negativity. There was displacement of the feared therapist/mother.

Many of these reactions matched my own. I had to sort out what was mine and what was theirs through their own particular stories and their own defences. There were complex differences in how the various anxieties were communicated, some being quite direct about their worries and others stirring my anxieties, seemingly trying to get rid of their feelings into me or other relationships.

Here was much of what I was going to talk about before I had prepared a word. There was projection, projective identification, displacement, denial, idealization, splitting, avoidance, identification and no doubt other mechanisms of defence.

My giving a public lecture was probably triggering our memories and feelings associated with being a small child in a family and having to cope with the parents’ separate life and the rest of the family.

My patients and I had to work through this.

Sorting out these reactions helped us to understand and hold all sorts of painful and difficult experiences.

There was the feeling of being exposed and vulnerable, but sometimes quite contrasting responses. Some had the fear that their private world would not be protected or respected, while others seemed to want to be exposed. These seemed related to various family histories such as an exposure to parents’ sex life, abusive relationships, rivalry with parents, hating feeling little, frightening mothers and fathers, desire to be in bed with parents, all accompanied by variations of guilt, anger, shame and anxiety. Sometimes sibling rivalry was unearthed.

This is working with the defences, working through the transference and countertransference.

It is fairly generally accepted that defences develop to protect one self from the emotional pain of life. We accumulate emotional experiences and these occupy an enlarging bank of unconscious knowledge. This requires some mechanisms to sort out and control. Defences or coping strategies may make life difficult but they make life bearable. We all use them.

Psychoanalytic therapy really aims to help people survive the inevitable pain of life in a more thoughtful way. This means developing the capacity to think about one’s emotions and those of others and of our impact on each other. We hope to be able to soothe hurt and settle upset feelings, and use anger in a productive way. Therapy aims to help people face life’s realities, recognising our strengths and our flaws and limitations, without having to split the world into goodies and baddies. Sadder but wiser. This is Melanie Klein’s depressive position.

This all has its roots in human development.

There is a vast body of careful observational and experimental studies on infant development, particularly that based on attachment theory. Fonagy and Target describe in their work the development of the infant’s emotional mind in the secure attachment to the mother. The “good enough mother” is able to think about her baby’s emotional experience and hold him through the traumas of infancy, helping him to develop a capacity to think about his internal and external emotional world. This they describe as mentalising which helps the development of self reflective function.

Ainsworth and her group devised a standardized test of babies’ responses to brief separations from their mothers. This was called the Strange Situation. Babies of 12 to 18 months were observed in response to mildly stressful situations, for example they put the babies in an unfamiliar room, a stranger appeared, and there were two three minute separations from their parent. They wanted to observe what happened when the babies were reunited with their mothers. The reunion episodes are the basis of their classification of attachment patterns.

There are broadly four ways the babies react. Approximately half of the children will be upset, seek contact with the parent, be comforted and resume play. These are the securely attached group. About a quarter of the group will appear undisturbed by the separations and will actively avoid their parent. These children were labelled as the avoidant group. Another smaller group will actively seek out their parent but will resist being comforted and continue to show signs of distress. These are the ambivalent group. A smaller group show confusion and disorganisation, which was at first seen as unclassifiable.

These reunion episodes provide a basis for inferring the nature of the child’s internalized relationship with his parent. The secure child expects help to alleviate his distress, while the other groups do not.

We can see in the insecure groups the behavioural evidence of early defence mechanisms. These babies have learnt to deny their feelings and avoid their mothers.

It is the smallest group which has provoked most interest and much work has been done studying this group. Main et al. described this small group of babies as the Disorganised group. The confusion and disorganization of these children may be evidence of the splitting and fragmentation of their minds.

The behaviour of this group is sometimes described as being a confusing mixture of avoidance and ambivalence. The disorganized pattern seems to be stable over time.

These babies go on to become bossy and difficult children who are controlling with their mothers and peers, insist on a kind of role reversal and are unable to engage in democratic play. Similarly many personality disordered people engage in therapy in this way. In the contemporary literature the disorganized group is being linked to Borderline Personality Disorder and Dissociative Disorders in adults.

Things get even more interesting when we look at the parents of the infants. Assessment using the Adult Attachment Interview shows that parents fall into similar groups to their children - secure, dismissing /detached, entangled and unresolved. Adults in the unresolved category give a disorientated and incoherent account of their childhood relationships, correlating with the disorganized infant group.

This is supported by “The ghost in the nursery”, a prospective study by Fonagy et al of pregnant women, demonstrating that mothers identified as being in the unresolved category went on to have disorganized babies. The babies were tested at 12 and 18 months. Fonagy comments that one of the least coherent interviews came from a successful courtroom lawyer when talking about her current anger with her mother. People can be intellectually capable but emotionally incapable.

The mother of the disorganized baby herself has usually been the subject of unresolved trauma and loss. It follows that her baby will trigger painful memories from her own childhood so she cannot provide her baby with the soothing and holding he needs for his emotional ups and downs. As well as being absent to his needs she may be frightened and frightening. The baby is stuck in an approach avoidance conflict.

Some unresolved mothers may be able to resolve their traumas themselves and improve their nurturing, whereas most will go on to repeat their own traumas .

In a recent paper by Lyons-Roth there is a vignette from a parent-infant treatment of a mother with her 11 month old baby boy which illustrates some of these issues. The mother was described as an attractive cheerful woman who was also recurrently suicidal, with active alcoholism and a severe trauma history. The mother was struggling to remain sober. In the beginning the therapist had very limited access to the mother’s inner world. However she could observe the mother’s psychological organization through her responses to her child. The therapist observed the trauma of absence rather than anger and abuse. The mother wanted to be a good mother but she found it difficult to know what to do when he was unhappy and he did not reach out for cuddling, closeness or comfort. By the time he was 18 months he was strongly resistant to limits and having frequent temper tantrums. Only much later when the mother began to trust the therapist did she finally reveal that, for the first eight months of his life, she could not bear him getting distressed. She felt helpless to settle him, would leave him to cry alone in his cot, and retreat to alcohol. She felt she hated him because he made her feel so helpless. How can this baby know how he feels when his mother doesn’t want to know? This baby has the experience of being known and not known.

Probably the babies with disorganized attachment patterns are demonstrating primitive defences in operation. These have been described particularly by Melanie Klein in her work with young children. She demonstrated projection, introjection, splitting and identification in her young patients’ attempts to deal with their violent and aggressive feelings about relationships with parents and siblings. In the ordinary course of events, the “good enough” mother is able to “contain” her baby’s emotional pain, ie, she is able to be receptive to what the baby is experiencing and evacuating, and translate this into a manageable interactive dialogue. Projective identification is how the young baby communicates. If the mother’s containment is absent primitive anxieties and defences can severely limit the emotional life of the infant. These primitive defence mechanisms are important because they determine the early personality, sense of identity and self.

Within the safe framework of a therapy childhood feelings are explored by looking beneath defences. Although the framework provides security, it also provokes hurt and angry feelings. Defences are mobilized to avoid feeling helpless, dependant, separate, attached and/or having to share. In therapy these very experiences are amplified. The framework is the structure of the therapy, i.e. the discipline of regular predictable sessions, with time limits, payment of fees, and holiday breaks. Although it may make sense to an adult it may feel hard and rejecting to the infant within.

Modern Psychoanalytic therapy focuses on the here and now, that is, the immediate situation between the therapist and the patient. All communication is heard through the filter of the transference and the countertransference. The use of the countertransference ( ie the feelings and phantasies aroused in the therapist) is the mainstay of modern psychoanalytic therapy, particularly in working with the more primitive personalities, where communication is more about discharge of feeling. This can be fraught with difficulties. What may sound insightful from the patient may feel deadening to a therapist, who may simply be tired or in a bad mood. Or is this a part of a recurring pattern that links in with the patient’s story? It can be like playing in the dark.

Great care has to be taken not to get caught up in re-enacting the vicious circle of projections. There are dangers of compliance, avoidance of experience, fragmenting, or development of false self.

The more primitive the defences and personality organization, the more difficult is the therapeutic task. Babies who are either disorganized, ambivalent or avoidantly attached do not allow contact with the maternal figure to deal with upset and angry feelings. Nor do patients with primitive personality organizations. For instance, one of my patients used to instantly fall asleep whenever I said anything that brought us together in an emotional way. Others dissociate in a less dramatic way, their minds switching off, while others will fragment, becoming confused.

The fragile stability of the primitively defended personality depends on getting rid of experience, ie violent projections in the therapeutic situation, into the therapist. There is then the expectation of retaliation with a vicious circle of negativity which can get set up. In the more maturely defended neurotic individual, communication is more the aim of the projections. Relationships (including the therapeutic relationship) are more realistically perceived with an expectation of a helpful response.

Slow and repetitive interpretation of the pattern of defences and the feelings underlying as well as the therapist’s constancy, reliability and attempts to hold and understand these difficult experiences will gradually allow the development of the good moderating experience which will, hopefully, become internalised.

This fragment of therapeutic work, hopefully, will illustrate some of the complexities of working with the defences and working through in the countertransference.

A middle aged man sought help because of pathological jealousy which was ruining his marriage. He himself was promiscuous, so there was considerable projection in his symptom.

I worked from home then and he was my first patient of the day. One day he was apparently earlier than usual and saw my partner leave for work. He did not tell me this at the time. It was many months later that he told me that, the day he had seen the man coming out of my house, he had gone straight from the session and engaged a prostitute. From that time on every time there was a break from the therapy his visits to prostitutes escalated. Interestingly his obsessive jealousy of his wife stopped when he took up with prostitutes.

This is a complex response. He was taking control, turning the tables, denigrating the object and denying dependence and jealousy. He knew and didn’t know. At the time I did not know what had happened. All I knew was that, suddenly, he was acting out with prostitutes when he felt abandoned.

I felt cross with him as he showed off about his sexual gymnastics and cross that he was betraying his wife and the therapy. I struggled to sit with these feelings, tried not to be too puritanical and authoritarian about this, probably not very successfully. This went on for months. All this time, he had not told me what he had seen.

Then one day a penny dropped. What came into my mind was the memory of a baby boy from my infant observation. His mother would leave him on the change table while she fixed his bottle. He would become distressed and cry, but one day he found his penis and settled himself for a while. This reflection changed my response to my patient. Suddenly my feelings about him shifted and I was able to feel softer and more understanding. It was only after I was able to talk to him with more empathy about his feeling abandoned, that he was able to tell me about what he had seen and his immediate, overwhelming need to see a prostitute in response.

I realised that what I had been feeling (cross, forced to watch his sexual exploits, and betrayed on behalf of his wife and the therapy) was how he must have felt seeing my partner – little, left out, cross with having seen this and betrayed by me.

This is an example of projective identification where his feelings were aroused in me and gradually I was able to work through this.

Historically his mother had been a very anxious and angry woman, who was particularly ferocious about her little boy’s sexual explorations. She was a frightened woman who could not cope with childishness. She was quite terrifying to her child. So, of course he both needed me but tried to avoid me.

Early in his therapy he would describe to me how crying babies would make him feel murderous, (an identification with his mother). Gradually over years of therapy his emotional attitude to upset children became much more tender and protective. He was able to move more to the depressive position.

It can be very difficult to “play babies” with someone who is always trying to boss you around, push horrible experiences onto you, and avoid you at the same time. It requires a somewhat disengaged but alive mind, a capacity to know and watch your own feelings without acting on them and being alert for the fantasies and thoughts that can pop into one’s mind. You need to know yourself to be able to help someone else know himself.

Every committed psychoanalytic experience will be a difficult journey. It is not a comfortable path for either participant. People come to therapy wanting to feel better and often find it disturbing that they can feel worse as we get beneath the defences and expose some of the pain of infancy. The big leap in therapy is to trust that someone else can help settle the feelings.

A A Milne’s Winnie the Pooh provides a metaphor for analytic work. In this particular story, Pooh is tracking the pawprints of something. He is joined by Piglet who suggests that it’s a woozle. They proceed tracking together and suddenly there are increasing numbers of woozle pawprints. They get frightened. Is it animals with Hostile Intent? Piglet is too scared to proceed, wishing his grandfather were there, and Pooh thought how nice it would be if they met Christopher Robin suddenly. Pooh looks up at the sky and there in the oak tree he sees his friend Christopher Robin who saves the day .He can see that Pooh and Piglet have been following their own tracks in a circle! Silly old Bear!

“I see now” said Winnie –the-Pooh. “I have been Foolish and Deluded” said he “and I am a Bear of No Brain at All”

Sometimes the analyst needs to climb into a tree! This might involve getting some distance or detaching oneself, finding a “third position” in one’s mind. It could also involve getting supervision or consulting with peers.

People’s minds can get very lost (Foolish, Deluded and No Brain at All) in tracking Woozles and the fear of Animals with Hostile Intent. A secure attachment with an expectation that someone can help, is vital in the development of the emotional mind that can face reality.

Early patterns of attachment remain very strongly throughout life and are difficult to shift, taking many years of intense work. The work is important though, particularly as these insecure patterns may roll on from one generation to the next.

References

Fonagy, P., Target, M. (1996). Playing With Reality: I. Theory Of Mind And The Normal Development Of Psychic Reality. Int. J. Psycho-Anal., 77:217-233.

Fonagy, P., Target, M. (1998). Mentalization and the Changing Aims of Child Psychoanalysis. Psychoanal. Dial., 8:87-114.

AINSWORTH, M., BLEHAR, M. C., WATERS, E. & WALL, S. 1978 Patterns of Attachment: A Psychological Study of the Strange Situation Hillsdale, NJ: Erlbaum.

MAIN, M. & SOLOMON, J. (1990). Procedures for identifying infants as disorganized/disoriented during the Ainsworth Strange Situation. In Attachment in the Preschool Years: Theory, Research and Intervention, ed. M. Greenberg, D. Cicchetti, & E.M. Cummings. Chicago: University of Chicago Press, pp. 121-160.

MAIN, M. & HESSE, E. (1990). Parents' unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In Attachment in the Preschool Years: Theory, Research and Intervention, ed. M. 909 Greenberg, D. Cicchetti, & E.M. Cummings. Chicago: University of Chicago Press, pp. 161-184.

Fonagy, P., Steele, M., Moran, G., Steele, H., Higgitt, A. (1993). Measuring the Ghost in the Nursery: An Empirical Study of the Relation Between Parents' Mental Representations of Childhood Experiences and their Infants' Security of Attachment. J. Amer. Psychoanal. Assn., 41:957-989.

Lyons-Ruth, K. (2003). Dissociation and the Parent-Infant Dialogue: A Longitudinal Perspective from Attachment Research. J. Amer. Psychoanal. Assn., 51:883-911.

Klein, M. (1975). Envy and Gratitude and Other Works 1946–1963: Edited By: M. Masud R. Khan. The International Psycho-Analytical Library, 104:1-346.

A A Milne (1926) Winnie-the -Pooh