혁신라이프코칭연수원 ICC

http://club.koreadaily.com/icclifecoach
전체글보기 클럽방명록  공동체 영상 정보   ICC 안내자료   도시와 자연의 영상 
 
  클럽정보
운영자 simonshin
비공개 개설 2016.07.20
인기도 607836
회원 79명
공동체 영상 정보 (82)
ICC 안내자료 (97)
ICP 안내자료 (75)
도시와 자연의 영상 (90)
신현근 박사 영상 강의 
정신분석의핵심개념 (18)
애도와 상실 (10)
Karen Horney의 정신분석 (74)
대인관계 정신분석 2 (35)
자아심리학 2 (34)
고전적 정신분석 (Freud) (168)
병리적 자기애와 공격성 (Kernberg) (60)
자기 심리학 (Kohut) (81)
임상 기법과 임상감독 (12)
인간성장이론 (12)
전이와 저항 (60)
클라인(Klein) 학파의 대상관계 이론과 그 역사 (58)
정신분열증 (10)
상호주관적 관계적 정신분석 (28)
비온의 대상관계 이론 (5)
강의안과 발제문 
현대정신분석의핵심개념 (5)
라이프코치양성 (23)
진단과평가 (17)
현대갈등이론 (13)
전인격적라이프코칭 (8)
회원자료 (5)
무의식적환상 (22)
현대정신분석의개입기법 (35)
정서적의사소통 (15)
정신분석기법과정신적 갈등 (23)
정신분석적사례이해 (26)
방어기제 (24)
정신분석의역사 (47)
고전적 정신분석 기법 (19)
신경증이론 (23)
대상관계이론의역사 (14)
자아심리학 (23)
현대정신분석 이론 (25)
페어베언의 성격 이론 (24)
성년기 발달 이론 (13)
위니코트의 대상관계 이론 (19)
ICC의 목표
추천링크
ICC YouTube
ICC 웹사이트
ICP, Seoul Korea
ICC 대표 신현근 박사
ICC의 네이버 블로그
ICC의 Moment 블로그
혁신라이프코칭학회 ICS
ICC의 Facebook Page
ICS의 Facebook Page
HeyKorean ICC
한국일보 블로그
ICP YouTube
 
TODAY : 246명
TOTAL : 1066138명
진단과평가
작성자  simonshin 작성일  2018.07.16 10:46 조회수 556 추천 0
제목
 신현근 박사 강의안: 일차적 (원시적) 방어 과정  
 

과목:  진단과 평가

주제:  일차적 (원시적) 방어 과정

강사신현근 박사

내용강의안

주교재: McWilliams, N. (2011). Psychoanalytic diagnosis (2nded.). New York: Guilford Press.

 

 

Primary (Primitive) Defensive Processes

1.       OVERVIEW

1.1.     The concept of defense has been central to psychoanalytic character diagnosis.

1.1.1.The major diagnostic categories that have been used by analytic therapists to denote personality types refer implicitly to the persistent operation in an individual of a specific defense or constellation of defenses.

1.1.2.Thus, a diagnostic label is a kind of shorthand for a person’s habitual defensive pattern.

1.2.    The phenomena that we refer to as defenses have many benign functions.

1.2.1.They begin as healthy, creative adaptations, and they continue to work adaptively throughout life.

1.2.2.When they are operating to protect the self against threat, they are discernible as “defenses,” a label that seems under those circumstances to fit. The person using a defense is generally trying unconsciously to accomplish one or both of the following: (1) the avoidance or management of some powerful, threatening feeling, usually anxiety but sometimes overwhelming grief, shame, envy, and other disorganizing emotional experiences; and (2) the maintenance of self-esteem.

1.3.    The preferential and automatic reliance on a particular defense or set of defenses is the result of a complex interaction among at least four factors:

1.3.1.(1) one’s constitutional temperament,

1.3.2.(2) the nature of the stresses that one suffered in early childhood,

1.3.3.(3) the defenses modeled— and sometimes explicitly taught— by parents and other significant figures, and

1.3.4.(4) the experienced consequences of using particular defenses (in the language of learning theory, reinforcement effects).

1.3.5.In psychodynamic parlance, the unconscious choice of one’s favorite modes of coping is “overdetermined,” expressing the cardinal analytic principle of “multiple function” (Waelder, 1960).

1.4.    Defenses have been extensively researched. Phoebe Cramer (2008) has reviewed empirical findings supporting seven core psychoanalytic observations; namely, that defenses

1.4.1.(1) function outside of awareness;

1.4.2.(2) develop in predictable order as children mature;

1.4.3.(3) are present in normal personality;

1.4.4.(4) become increasingly used in times of stress;

1.4.5.(5) reduce the conscious experience of negative emotions;

1.4.6.(6) operate via the autonomic nervous system; and

1.4.7.(7) when used excessively, are associated with psychopathology.

1.5.    Substantial agreement exists among psychoanalytic scholars that some defenses are less developmentally mature than others.

1.5.1.In general, defenses that are referred to as “primary” or “immature” or “primitive” or “lower order” involve the boundary between the self and the outer world.

1.5.2.Those conceived as “secondary” or “more mature” or “advanced” or “higher order” deal with internal boundaries, such as those between the ego or superego and the id, or between the observing and the experiencing parts of the ego.

1.6.    The conceptual division between more archaic and higher-order defenses is somewhat arbitrary.

1.6.1.Ever since Kernberg (e.g., 1976) called attention to borderline clients’ use of archaic forms of projection and introjection (a precursor of identification), however, many therapists have followed him in identifying the following defenses as intrinsically “primitive”: withdrawal, denial, omnipotent control, primitive idealization and devaluation, projective and introjective identification, and splitting.

1.6.2.In 1994 I suggested adding extreme forms of dissociation to that list.

1.6.3.And now, based on the work of Vaillant (e.g., Vaillant et al., 1986) and other researchers with which I was not so familiar in 1994, and at the suggestion of several colleagues, I have added somatization, acting out, and sexualization to the more primitive defenses.

1.7.    To be considered primary, a defense typically has two qualities associated with the preverbal phase of development: a lack of attainment of the reality principle (see Chapter 2) and a lack of appreciation of the separateness and constancy of those outside the self.

1.8.    It is the absence of mature defenses, not the presence of primitive ones, that characterizes borderline or psychotic structure.

1.9.    It is much harder to describe the primitive defenses than the more advanced ones.

 

2.       EXTREME WITHDRAWAL

2.1.    An infant who is overstimulated or distressed will often simply fall asleep. Withdrawal into a different state of consciousness is an automatic, self-protective response that one sees in the tiniest of human beings.

2.1.1.Adult versions of the same process can be observed in people who retreat from social or interpersonal situations, substituting the stimulation of their internal fantasy world for the stresses of relating to others.

2.1.2.A propensity to use chemicals to alter one’s consciousness can also be considered a kind of withdrawal.

2.1.3.Some professionals, including contributors to recent editions of the DSM, prefer the term “autistic fantasy” to withdrawal; this label refers to a specific version of the general tendency to shrink from personal contact.

2.2.    Some babies are temperamentally more inclined than others toward this way of responding to stress; observers of infants have sometimes noted that it is the babies who are especially sensitive who are most likely to withdraw.

2.2.1.People with this constitutionally impressionable disposition may generate a rich internal fantasy life and regard the external world as problematic or affectively impoverished.

2.2.2.Experiences of emotional intrusion or impingement by caregivers and other early objects can reinforce withdrawal; conversely, neglect and isolation can also foster that reaction by leaving a child dependent on what he or she can generate internally for stimulation.

2.3.    Schizoid personality styles are the characterological outcome of reliance on the defense of withdrawal.

2.4.    The obvious disadvantage of withdrawal is that it removes the person from active participation in interpersonal problem solving.

2.4.1.People who chronically withdraw into their own minds try the patience of those who love them by their resistance to engaging on a feeling level.

2.4.2.Those with serious emotional disturbance are hard to help because of their apparent indifference to the mental health workers who try to win their attention and attachment.

2.5.    The main advantage of withdrawal as a defensive strategy is that while it involves a psychological escape from reality, it requires little distortion of it.

2.5.1.People who depend on withdrawal console themselves not by misunderstanding the world but by retreating from it. Consequently, they may be unusually sensitive, often to the great surprise of those who write them off as dull nonparticipants.

2.5.2.And despite their lack of a disposition to express their own feelings, they may be highly perceptive of feelings in others.

2.5.3.On the healthier end of the schizoid scale, one finds people of remarkable creativity: artists, writers, theoretical scientists, philosophers, religious mystics, and other highly talented onlookers whose capacity to stand aside from ordinary convention gives them a unique capacity for original commentary.

 

3.       DENIAL

3.1.    Another early way in which infants can handle unpleasant experiences is by refusing to accept that they are happening.

3.1.1.Denial lives on automatically in all of us as our first reaction to any catastrophe; the initial response of individuals who are informed of the death of someone important to them is typically “Oh, no!”

3.1.2. This reaction is the shadow of an archaic process rooted in the child’s egocentrism, in which a prelogical conviction that “If I don’t acknowledge it, it isn’t happening” governs experience.

3.1.3.It was processes like this one that prompted Selma Fraiberg to title her classic popular book The Magic Years (1959).

3.2.    The clearest example of psychopathology defined by the use of denial is mania.

3.2.1.In manic states, people may deny to an astonishing degree their physical limitations, their need for sleep, their financial exigencies, their personal weaknesses, even their mortality.

3.2.2.Where depression makes the painful facts of life supremely unignorable, mania makes them seem insignificant.

3.2.3.Analysts may refer to those who use denial as their main defense as hypomanic (the “hypo” prefix, meaning “a little” or “somewhat,” distinguishes them from those who suffer full manic episodes).

3.2.4.They have also been termed “cyclothymic” (“ alternating emotion”), because of their tendency to cycle between manic and depressed moods, usually short of diagnosable bipolar illness. We understand this oscillation as the repetitive use of denial followed by its inevitable collapse as the person becomes exhausted in the manic condition.

3.3.    As with most primitive defenses, unmodified denial in adults is usually cause for concern.

3.3.1.Nonetheless, mildly hypomanic people can be delightful.

4.       OMNIPOTENT CONTROL

4.1.    For the newborn, the world and the self are felt more or less as one.

4.1.1.Fonagy’s research (Fonagy et al., 2003) suggests that infants live for about 18 months in a mental state of “psychic equivalence,” in which the external world is felt as isomorphic with the internal one.

4.1.2.Piaget recognized this phenomenon (e.g., 1937) in his concept of “primary egocentrism” (a cognitive phase roughly equivalent to Freud’s [1914b] “primary narcissism,” during which primary process thought prevails).

4.1.3.It may be that the source of all events is understood by the newborn as internal in some way; that is, if the infant is cold, and a caregiver perceives this and provides warmth, the baby has some preverbal experience of its having magically elicited the warmth.

4.1.4.The awareness that there is a locus of control in separate others, outside the self, has not yet developed.

4.2.    A sense that one can influence one’s surroundings, that one has agency, is a critical dimension of self-esteem, one that may begin with infantile and unrealistic but developmentally normal fantasies of omnipotence.

4.2.1.It was Sandor Ferenczi (1913) who first called attention to the “stages in the development of a sense of reality.” 

4.2.2.He noted that at the infantile stage of primary omnipotence or grandiosity, the fantasy that one controls the world is normal; that this naturally shifts, as the child matures, to a phase of secondary or derived omnipotence in which one or more caregivers are believed to be all-powerful; and that eventually, the maturing child comes to terms with the unattractive fact that no one’s potency is unlimited.

4.2.3.A precondition for the mature adult attitude that one’s power is not boundless may be, paradoxically, the opposite emotional experience in infancy: a secure enough early life that one can freely enjoy the developmentally appropriate illusions of, first, one’s own omnipotence, and second, that of those on whom one depends.

4.2.4.The conviction that individuals can do anything they set their mind to is a piece of American ideology that flies in the face of common sense and most human experience, but it nonetheless can be a powerfully positive and self-fulfilling fiction.

4.3.    If one’s personality is organized around seeking and enjoying the sense that one has effectively exercised one’s power, with all other practical and ethical concerns relegated to secondary importance, one’s personality is in the psychopathic range (“ sociopathic” and “antisocial” are terms of later origin).

4.3.1.Nonprofessionals frequently assume that most criminals are psychopaths and vice versa.

4.3.2.Yet many people who rarely break the law have personalities driven by the defense of omnipotent control, as in the corporate “snakes in suits” described by Babiak and Hare (2007).

4.3.3.They use conscious manipulation as a primary way of avoiding anxiety and maintaining self-esteem.

4.4.    Getting over on” others is a central preoccupation and pleasure of individuals whose personalities are dominated by omnipotent control (Bursten, 1973a).

4.4.1.Such people are common in enterprises that require guile, a love of stimulation or danger, and a willingness to subordinate other concerns to the central objective of making one’s influence felt.

 

5.       EXTREME IDEALIZATION AND DEVALUATION

5.1.    We all idealize.

5.1.1.We carry remnants of the need to impute special value and power to people on whom we depend emotionally.

5.1.2.Normal idealization is an essential component of mature love (Bergmann, 1987).

5.1.3.And the developing tendency over time to deidealize or devalue those to whom we have childhood attachments seems to be a normal and important part of the separation– individuation process.

5.1.4.In some people, however, the need to idealize seems relatively unmodified from infancy.

5.1.4.1.               Their behavior shows evidence of the survival of archaic and rather desperate efforts to counteract internal terror by the conviction that some attachment figure is omnipotent, omniscient, and omnibenevolent, and that through psychological merger with this wonderful Other, they are safe.

5.1.4.2.              They also hope to be free of shame: A by-product of idealization and the associated belief in perfection is that imperfections in the self are harder to bear; fusion with an idealized object is an attractive remedy.

5.2.    Longings for the omnipotent caregiver naturally appear in people’s religious convictions; more problematically, they are evident in phenomena like the insistence that one’s lover is perfect, one’s personal guru is infallible, one’s school is the best, one’s taste is unassailable, one’s government is incapable of error, and similar illusions. People in cults have been known to die rather than devalue a leader who has become crazy.

5.3.    People who live their lives seeking to rank all aspects of the human condition according to how comparatively valuable they are, and who appear motivated by a search for perfection through merger with idealized objects, efforts to perfect the self, and tendencies to contrast the self with devalued alternatives, have narcissistic personalities.

5.3.1.Self-esteem strivings in people who need to idealize and devalue are contaminated by the idea that one must perfect the self rather than accept it.

5.4.    Primitive devaluation is the inevitable downside of the need to idealize.

5.4.1.Since nothing in human life is perfect, archaic modes of idealization are doomed to disappointment.

5.4.2.The more an object is idealized, the more radical the devaluation to which it will eventually be subject.

5.4.3.The bigger one’s illusions, the harder they fall.

5.5.    In ordinary life, one can see analogues of this process in the degree of hate and rage that can be aimed at those who seemed to promise much and then failed to deliver.

5.6.    Some people spend their lives running from one intimate relationship to the next, in recurrent cycles of idealization and disillusionment, trading the current partner in for a new model every time he or she turns out to be a human being.

5.6.1.The modification of primitive idealization is a legitimate goal of all long-term psychoanalytic therapy, but that enterprise has particular relevance in work with narcissistic clients because of the degree of unhappiness in their lives and in those of the people who try to love them.

 

6.       PROJECTION, INTROJECTION, AND PROJECTIVE IDENTIFICATION

6.1.    I am combining the discussion of two of the most primitive defensive processes, projection and introjection, because they represent opposite sides of the same psychological coin.

6.1.1.In both projection and introjection, there is a permeated psychological boundary between the self and the world.

6.2.    Projection is the process whereby what is inside is misunderstood as coming from outside.

6.2.1.In its benign and mature forms, it is the basis for empathy.

6.2.1.1.              Since no one is ever able to get inside the mind of another person, we must use our capacity to project our own experience in order to understand someone else’s subjective world.

6.2.1.2.              Intuition, leaps of nonverbal synchronicity, and peak experiences of mystical union with another person or group involve a projection of the self into the other, with powerful emotional rewards to both parties.

6.2.1.3.              People in love are well known for reading one another’s minds in ways that they themselves cannot account for logically.

6.2.2.In its malignant forms, projection breeds dangerous misunderstanding and untold interpersonal damage.

6.2.2.1.              When the projected attitudes seriously distort the object on whom they are projected, or when what is projected consists of disowned and highly negative parts of the self, all kinds of difficulties can ensue.

6.2.2.2.              Others resent being misperceived and may retaliate when treated, for example, as judgmental, envious, or persecutory.

6.2.2.3.               A person who uses projection as his or her main way of understanding the world and coping with life, and who denies or disavows what is being projected, can be said to have a paranoid character.

6.3.    Introjection is the process whereby what is outside is misunderstood as coming from inside.

6.3.1.In its benign forms, it amounts to a primitive identification with important others.

6.3.1.1.              Young children take in all kinds of attitudes, affects, and behaviors of significant people in their lives.

6.3.1.2.              The process is so subtle as to be mysterious, although recent studies of mirror neurons and other brain processes are starting to shed light on it.

6.3.1.3.              Long before a child can make a subjectively voluntary decision to be like Mommy or Daddy, he or she seems to have “swallowed” them in some primal way.

6.3.2.In its problematic forms, introjection can, like projection, be highly destructive.

6.3.2.1.              The most striking examples of pathological introjection involve the process that has been labeled, somewhat inappropriately in view of its primitivity, “identification with the aggressor” (A. Freud, 1936).

6.3.2.1.1.                    It is well known, from both naturalistic observations (e.g., Bettelheim, 1960) and empirical research (e.g., Milgram, 1963), that under conditions of fear or abuse, people will try to master their fright and pain by taking on qualities of their abusers.

6.3.2.2.              Introjection is also implicated in some kinds of depressive psychology (Blatt, 1974, 2004).

6.3.2.2.1.                    When we are deeply attached to people, we introject them, and their representations inside us become a part of our identity.

6.3.2.2.2.                    If we lose someone whose image we have internalized, whether by death, separation, or rejection, not only do we feel that our environment is poorer for that person’s absence in our lives but we also feel that we are somehow diminished, that a part of our self has died.

6.3.2.2.3.                    A person who is unable over time to separate internally from a loved one whose image has been introjected, who consequently fails to invest emotionally in other people (the function of the grieving process), will continue to feel diminished, unworthy, depleted, and bereft.

6.3.2.2.4.                    Similarly, children in destructive families prefer to believe there is something wrong with them (preserving hope that by changing, they can improve their lot), than to take in the terrifying fact that they are dependent on negligent or abusive caregivers.

6.3.2.2.4.1.   Fairbairn (1943) called this process the “moral defense,” noting that it is “better to be a sinner in a world ruled by God than to live in a world ruled by the Devil” (pp. 66– 67).

6.3.2.2.5.                    If one regularly uses introjection to reduce anxiety and maintain continuity in the self, keeping psychological ties to unrewarding objects of one’s earlier life, one can reasonably be considered characterologically depressive.

6.4.    Melanie Klein (1946) was the first analyst to write about a defensive process that she found to be ubiquitous in more disturbed patients, which she called “projective identification.”

6.4.1.Projective identification is a particularly powerful and challenging operation, one that strains the therapist’s capacities.

6.4.2.In projective identification, not only does the patient view the therapist in a distorted way that is determined by the patient’s past object relations; in addition, pressure is exerted on the therapist to experience himself in a way that is congruent with the patient’s unconscious fantasy. (Ogden, 1982)

6.4.3.In particular, because the projective piece of it is so powerful, it is associated with borderline levels of paranoid personality.

6.4.4.Contrary to professional popular opinion, however, projective identification is not used exclusively by people whose character is essentially borderline.

 

7.       SPLITTING OF THE EGO

7.1.    Splitting of the ego, usually referred to simply as “splitting,” is the other interpersonally powerful process that is understood as deriving from a preverbal time, before the infant can appreciate that his or her caregivers have good and bad qualities and are associated with good and bad experiences.

7.2.    In everyday adult life, splitting remains a powerful and appealing way to make sense of complex experiences, especially when they are confusing or threatening.

7.3.    The mechanism of splitting can be very effective in its defensive functions of reducing anxiety and maintaining self-esteem.

 

8.       SOMATIZATION

8.1.    Somatization is what analysts have called the process by which emotional states become expressed physically.

8.1.1.Although it is common to conflate somatization with malingering, the somatic experience of being emotionally unwell in ways that are unverbalizable is not equivalent to pretending to be ill in order to extract sympathy or avoid a responsibility.

8.1.2.Nor does it equate with a problem’s being “all in your head.” The brain is a part of one’s physicality, not a detached overseer.

8.2.    A person complaining to a therapist of physical pain or exhaustion is using the defense of somatization should not be reached unreflectively.

 

9.       ACTING OUT (DEFENSIVE ENACTMENT)

9.1.    As noted above, the other way young children express unverbalizable states of mind is by acting them out.

9.2.     In the first edition of this book, I put acting out with the more mature defenses because in the chapter on primary defensive processes I was concentrating on the processes that Kernberg (1984) had explicated in connection with borderline and psychotic conditions.

9.3.    I think now that even though it characterizes healthy as well as more troubled individuals, it is a mistake to frame enactment as a second-order process: Putting into action what one lacks the words to express is by definition a preverbal operation.

 

10.   SEXUALIZATION (INSTINCTUALIZATION)

10.1.                     Sexualization usually takes an enacted form and might be considered a subtype of acting out.

10.2.                     I have chosen to present it separately, though, partly because it is possible to sexualize without acting out (a process that is more accurately referred to as erotization) and partly because it is a concept of such general and interesting significance that it deserves some special attention.

 

11.   EXTREME DISSOCIATION

11.1.                     I have put extreme dissociation with the primary defenses here, both because it works so globally on the total personality and because many dissociated states are essentially psychotic.

11.2.                      Since the first edition of this book, however, I have become increasingly sensitized to the range of dissociative reactions and the inadvisability of restricting our use of the term “dissociation” to the overwhelming, shock-trauma versions of the defense.

 

12.   SUMMARY

12.1.                      In this chapter I have described defenses that analysts conventionally consider primitive or primary: extreme withdrawal, denial, omnipotent control, extreme idealization and devaluation, primitive forms of projection and introjection, splitting, somatization, enactment, sexualization, and extreme forms of dissociation.

12.2.                     I have reviewed the assumed normal origins of each defense and mentioned adaptive and maladaptive functions of each. I have also identified the personalities and syndromes associated with heavy reliance on each primary defense.


 
 
 
 
이전글   다음글이 없습니다.
다음글   이전글이 없습니다.