In these blogs I’m going to talk about common questions and issues we struggle with as therapists as part of our mission to help you help others. A lot of times people naively assume that therapy is “easy” as if all we have to do is “talk” to people. But as you know, therapy can be incredibly hard. My job in this blog is to have a dialogue with you, answering questions you raise, as we co-create this blog and our ISTDP community. So here goes. Today I’m going to talk a little about defense.
When we explore a patient’s problems we want to find out what defenses the patient uses. Why? Defenses create the patient’s symptoms and presenting problems. If we can help the patient see how his defenses create his problems, he will be much more motivated to turn against them and face his feelings instead. In that sense, defenses are the pathology creation system. It is not so much that a patient “has” depression. Rather, every ten to twenty seconds the patient uses a defense that causes depression. If the patient turns anger onto himself, dismisses, criticizes, and doubts himself three to four times a minute for sixteen hours a day, we should not be surprised that after over 2000 attacks on the self the patient feels depressed. These defenses are cruel to the patient. So it is an act of compassion for the therapist to interrupt and point out every defense that hurts the patient. Every time you point out a defense to the patient your meta-communication is this: “I don’t want you to hurt yourself.”