Empathizing with defences

Working with defences seems central to how we find a way to the child or adolescent through child psychotherapy. Frequently young people are referred to us when their defences or coping strategies are no longer serving them well.  A child whom had managed feelings of inferiority through being the class clown now struggles to be anything other. The child whom had experienced profound neglect finds they cannot stop stealing even when they now receive good care. The adolescent whom had been overly compliant, now finds their relationships with peers are marred by being dominated by others. The adolescent whom had tried not to worry their parents with their own worries, develops an increasing array of somatic symptoms.

The psychoanalytic thinking of Anna Freud (whom wrote what continues to be the seminal work in the field, The Ego and The Mechanisms of Defence), established that defences feel a necessity and have to be understood as the child’s often desperate way of trying to preserve or establish their ego functioning.  Anne Alvarez has taken up this thread from a Kleinian perspective

(2012). Her work is steeped in the Kleinian tradition of the paranoid schizoid and depressive positions, yet her arguments for different levels of therapeutic work do chime very much with Anna Freud’s arguments, for recognizing the fragility of some children’s defences and adjusting our technique accordingly.  We have to remember that for some children their defences are their only way of managing and may feel a matter of life and death.

Although we may associate psychoanalysis with the concept of defences, it does not have the last word on them. We now have a rich history of attachment research and attachment informed clinical practice. As Jeremy Holmes (2001) has argued, attachment based practice sees defences more relationally and interpersonally, rather than keeping to the purely analytic intrapsychic focus.  This views defences in terms of how the child relates to others not just to themselves. Hence, attachment styles can be viewed as forms of defences the individual has found necessary to develop, in order to cope with or manage their key attachment relationships. Thus the child whom minimizes their worries in order to not worry their parents, may have found this is the best way of eliciting caregiving behaviour from their parent and that to seek direct support might in fact lead to the opposite.

As an integrative child psychotherapist, my own approach is informed by the analytic models cited, but also recognizes the significance of viewing defences from an attachment perspective.  I have been greatly helped in my thinking, through the attachment informed clinical work of Daniel Hughes and his Dyadic Developmental Psychotherapy model. Hughes (2007) states:-

‘…when the child does not have to defend his experience he can explore it openly.’

Hughes curious, playful and most significantly, empathic therapeutic stance, approaches defences, in such a way that the child may feel safe enough to explore his experience with the therapist, rather than defend against it.  As we have seen in my previous posts, enabling the child to feel safe in our sessions is paramount. We are the psychobiological regulator of the child and if we wish to help them explore their experience less defensively then they will need to feel emotionally regulated.

For me, it therefore feels, that a marrying of the analytic approach to defences with attachment informed practice, creates a stance where one is, ‘empathizing with the defence.’  This means there is the analytic understanding from Anna Freud and Alvarez about the unconscious processes at work and why the defence feels necessary at this moment in time. Yet the therapeutic technique employed to ‘work with the defence,’ is one that is informed by attachment theory and research. In practice this means we may need to tiptoe up to the defence (Lanyado 2003) with empathy and consider the interpersonal context of the therapeutic relationship in which we are addressing the defence.  We know that empathy is regulating to the stress response system. Through mentalizing our client, holding their mind in our mind and conveying this empathically through our understanding of why they may need the defence, we may avoid the potential dysregulation aroused by approaching defence. So our clients may feel through our empathy for their defence, that we are tiptoeing up to it.  This is vital, for as stated by Vaillant (1992) we must:-

‘Never try to challenge a defence unless you have the time, love and patience to share responsibility for the consequences.’

We must therefore begin by empathizing with the need for the defence, focusing upon this first before any attempt is made to reach the core anxiety it may be protecting. For some children this may be a gateway to then thinking with them about the core anxiety or psychic pain that they are trying to eschew; for others just empathizing with the nature of the defence itself is the work. For example, to an autistic child with learning difficulties, we may empathise with their need to show us all the letters or words they can now write, rather than focus on the core anxiety of feeling how much they don’t know compared to their peers.

So one might say, ‘It feels important I notice how many things you know. It feels good to be the one who knows.’ (empathizing with the defence)

Rather than,

 ‘I see you trying very hard to practice your spelling. I wonder if it feels very hard sometimes to learn things?’ (the core anxiety of feeling they don’t know).

Anna Freud very much argued for analyzing ego defences and Alvarez has similarly demonstrated how vital it is for some children that we preserve their fragile ego’s through building up their defences and not interpreting their core anxiety, as has been the more traditional Kleinian technique.  We therefore have a choice when working with defences. Do we empathise with the defence or do we empathise with the core anxiety? To make this decision we need to think what the child can bear at this time and what is likely to be the most growth enhancing intervention. For some children they may very much need us to think about their core anxieties and they may experience a great relief in finding someone whom can bear these anxieties with them. For others, they may need us to ‘sure up’ their fragile defences, so that they can manage better being in relationship to themselves and to others.

 

References

Alvarez, A (2012) The Thinking Heart. Three Levels of Psychoanalytic work with disturbed children. London: Routledge

Freud, A (1936) The Ego and The Mechanisms of Defence

Hughes, D (2007) Attachment Focused Family Therapy. Norton

Holmes, J (2001) The Search for The Secure Base: Attachment Theory and Psychotherapy. London: Routledge

Lanyado, M (2003) The Presence of the Therapist: Treating Childhood Trauma

Vaillant, G (1992) Ego Mechanisms of Defense: A Guide for Clinicians and Researchers, Washington, DC, American Psychiatric Press