Mirroring Defenses

“I would like to hear you speak more about this intervention of mirroring defenses. I have found myself spontaneously doing this is in an almost exaggerated way to try to make defenses less syntonic with decent results. When do we mirror defenses and when do we invite feelings and invite the patient to let go of his defenses?” Thanks to one of our community members for this question!

Since defenses occur outside of the patient’s awareness, first we help the patient see the defenses that create his presenting problems and symptoms. We do this in three steps: 1) point out and identify the defense; 2) clarify the price and function of the defense; and 3) challenge the defense, i.e., encourage the patient to let go of the defense and face his feelings. This is often enough to help patients let go of their defenses, face their feelings, and have a good therapy result.

For some patients, however, this is not enough. They are identified with the defense. They claim the defense is good and helpful. They say they intend to continue using the defense, knowing full well that the defense is causing their problems. How do we understand this?

At this point, the patient is no longer using a defense to ward off a feeling. The patient is enacting a past relationship to avoid feelings rising toward the therapist that are related to that past relationship. For instance, a patient grew up with a father who sexually abused her. Her mother knew this but did not stop it. In fact, the mother told her daughter to put on a smile when she left the house each morning to go to school.

In therapy, a surprising enactment occurred. The patient reported a self-destructive relationship she had. She knew it was destructive and saw clearly how she set herself up. The therapist pointed this out repeatedly but to no effect. Meanwhile, the therapist felt helpless and frustrated.

The patient was acting out the role of the mother who could have stopped a molesting husband but claimed to be helpless to do so. The therapist was in the daughter’s role, helpless and frustrated. This enactment of a past relationship is known as the transference resistance.

In traditional psychoanalysis, the analyst interprets this enactment so the patient can remember rather than repeat the past relationship. Sometimes, however, interpretation does not help. The patient simply learns to intellectualize about her self-destructive activities rather than change them.

In ISTDP, modern psychoanalysis, and other experiential approaches, the therapist offers a new experience, not an interpretation. The therapist does this with the transference resistance in four ways: blocking the projection of the patient’s healthy wishes, deactivating the patient’s identification with her mother, deactivating the regressive wish, and deactivating the omnipotent transference. That’s a mouthful. Let me explain.

When the patient is destructive, she encourages the therapist to speak up for her health: projection of the patient’s healthy wishes.

When the patient says she is helpless to do anything else she is identified with her mother: identification with the resistance.

When she comes to therapy, consciously acting out destructively, she expects the therapy to help when she is sabotaging it: the regressive wish (I want to be healed without having to do anything.).

When she acts destructively against her goals and therapy, she asks the therapist to take all the responsibility for her recovery: the omnipotent transference.

These are all elements of the patient’s suffering. When the patient’s mother enabled the father’s cruelty and abuse, the patient was left with the sole responsibility for speaking the truth.

When the patient’s mother sabotaged the relationship and asked the patient to smile, this was her regressive wish: to have a perfectly happy daughter while she created a perfectly horrible family.

And when the mother acted so destructively, she asked the daughter to take all the responsibility for stopping the abuse. This was an impossible situation for the patient, and it would be one for the therapist too.

The patient, through enactment, is simply telling the story of her suffering which she has not been able to put into words. Although the enactment, in one sense, is a resistance to putting the past into words, it is also an unconscious act to facilitate the healing the patient needs. So we enter into the enactment, saying to the patient what the daughter was never able to say to the mother.

When the patient enacts her identification with her mother, she expects the therapist to speak up for her health. If the therapist does so, the conflict is between the patient and therapist rather than between the patient and her resistance. When the patient uses a defense (now express my healthy wishes), the therapist mirrors the defense. This blocks the projection and the patient experiences internal conflict within herself rather than between her and the therapist.

Pt: There’s nothing I can do. I can’t help it. [Identification with the mother]

Th: I’m sorry to hear that. [Block projection of responsibility]

Pt: What do you mean?

Th: If you cannot leave your husband who hits you, we have to accept that. [Block projection of responsibility]

Pt: [rise of anxiety] Isn’t there something you can do? [Projection of responsibility]

Th: No. I can’t leave him for you. Only you can do that. [Block projection of responsibility, deactivate omnipotent transference]

Pt: I’m sorry I just can’t do anything about it.

Th: That’s a shame.

Pt: What do you mean?

Th: Then we won’t be able to achieve your goal. [Blocking the regressive wish: I want to take a passive stance and have a great result anyway.]

We mirror the patient’s defenses only when the patient is identified with them, i.e., when we have a character or transference resistance. At other times in therapy, mirroring a defense will cause a misalliance because you would be treating a patient as more resistant than she is. Often, therapists are angry with a resistant patient. So when they mirror the defenses, they do so sarcastically or in an exaggerated manner. This will cause a misalliance. Never try to be sarcastic with a patient. When we mirror defenses, we should do so carefully, tuning in to the exact kind of history the patient is revealing through her enactment.

Take home point: mirror defenses only when the patient is identified with them while enacting a character resistance or the transference resistance. Also, only mirror the level of resistance the patient demonstrates. Otherwise, you will create a misalliance. This requires us to identify with the patient more completely so that by mirroring her resistance, we join her in a way that she begins to see herself, resistance and all.


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One response to “Mirroring Defenses”

  1. Albert Avatar
    Albert

    Thank you for this post Jon! It’s good to see you updating this blog again.

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