Defense Mechanisms | Therapy Terms

Defense Mechanisms

Therapy Terms

Free Association: Technique invented by Freud as a replacement for hypnosis as a tool for accessing unconscious material. By noticing apparent gaps in associations, psychoanalysts can pick up resistances and clues to unconscious material.

Resistance: Resistance reflects the patient’s use of defenses in the therapy to avoid unpleasant emotions, but also to resist change. Examples include silences, missed appointments, forgetting, refusing medication and/or dismissing other interventions the therapist makes. Resistance is a window into the patient’s past and internal mind and is explored together in therapy.

Transference: The unconscious mechanism by which patients experience the doctor as a significant figure from the past and thus feelings from the past are reactivated in the here and now with the therapist. Transference occurs in all relationships, but one aspect of dynamic psychotherapy is that the transference is utilized as a tool with which to understand and ultimately modify past patterns of relationships.

Countertransference: The set of feelings evoked in the therapist by the patient. Thought to be a joint creation of feelings induced by the patient via projective identification and unresolved conflicts from the therapist’s past. The therapist must be highly self-aware in order to separate his/her own conflicts from the aspect of countertransference that is useful information about the patient’s internal world.

Therapeutic Alliance: The shared positive feelings between therapist and patient, relatively free of transference distortion, which support their pursuit of the goals of the treatment (see post on Therapeutic Alliance).

Working Through: The repetitive interpretation of transference and resistance until it is integrated by the patient. The therapist points out patterns in the patient’s outside relationships and relates it to patterns in the relationship with the therapist and in early relationships. It is thought that by re-experiencing these patterns in the relationship with the therapist, they are gradually modified and reintegrated.

Termination: Termination is the final phase of the therapy during which the patient reviews the work of the treatment and prepares for the future. The termination phase is likely to reawaken conflicts that have been explored earlier in the treatment, especially conflicts related to separation and autonomy.


Therapeutic Interventions

Supportive Therapy-Oriented Techniques: Used in most forms of therapy to varying degrees. Examples include

  • Encouragement to elaborate: “Tell me more.”
  • Empathic validation: “That must have been very stressful”
  • Advice
  • Praise: “I am so proud of you for using those coping skills!”
  • Affirmation: “I see. Uh huh”

Psychoanalytic/Psychodynamic-Oriented Techniques:

  • Clarifications are questions and statements designed to elucidate the patient’s current thoughts, feelings, and/or behavior
  • Confrontations gently point out contradictions that might imply unconscious conflict.
  • Interpretations are the therapist’s attempt to link the patient’s conscious thoughts, feelings or behavior to unconscious motivations.