From Self-Protection to Relational Protectiveness: The Modification of Defensive Structures

Abstract

Kohut was instrumental in shifting our attention from the removal of individual defenses in the service of making the unconscious conscious to emphasizing the importance of empathically understanding the healthy, self-protective usefulness of defenses, both developmentally and during the therapeutic process. Despite this pivotal change in reactive tone toward defenses, there have been few experiences near attempts to describe how we help patients to modify characterological defenses that interfere with the healing process. In this article, I suggest that one of the most important but unrecognized ways we work through these resistances is by facilitating a shift in the patient from the need for self-protective defensiveness to a felt relational protectiveness. Verbatim clinical examples illustrate a protective attitude and explain how relational protectiveness is actualized when dealing with characterological defenses.

Kohut a contribué à infléchir l’attention que nous portions à l’élimination des défenses individuelles pour rendre l’inconscient conscient, et à l’orienter vers une compréhension empathique de la fonction autoprotectrice des défenses, autant dans le développement que dans le processus thérapeutique. Malgré ce changement de tonalité important dans la perception des défenses, on recense peu de tentatives pour décrire de manière « proche de l’expérience » comment aider nos patients à modifier les défenses de type caractériel qui interfèrent avec le processus de guérison. Dans cet article, je suggère que l’une des façons encore méconnue de composer avec ces résistances consiste à faciliter chez le patient la transformation du besoin défensif de se protéger en sentiment d’être protégé relationnellement. Des exemples cliniques illustrent ce procédé et proposent une mise en oeuvre de cette protection relationnelle lorsque nous sommes aux prises avec des défenses caractérielles.

Kohut e’ stato determinante nello spostare la nostra attenzione dall’eliminazione delle difese individuali al fine di rendere conscio l’inconscio, all’ importanza crescente attribuita alla comprensione empatica dell’utilità salutare e autoprotettiva delle difese sia in età evilutiva che nel corso del processo terapeutico. Nonostante il  riorientamento dei toni reattivi nei confronti delle difese, ci sono state ben pochi tentativi vicini all’esperienza volti a descrivere il modo in cui aiutiamo i pazienti a modificare difese caratteriali  che interferiscono con il processo di guarigione. In questo lavoro sostengo che uno dei modi piu’ importanti ma poco riconosciuti, attraverso i quali elaboriamo queste difese, consiste nel facilitare uno spostamento nel paziente dal bisogno di autoprotezione difensiva ad una relazionalità percepita  come protettiva. Esempi clinici illustrano in dettaglio un atteggiamento protettivo e spiegano  come una protettivita’ relazionale viene posta in essere nel trattare difese caratteriali.

Keywords:

• connectedness
• defense
• defensive structure
• empathy

Notes

¹ For some individual exceptions, see Doctors (2009), Ornstein (1974, 1991, 2009), Brandschaft (1994, 2007), and Tropp and Stolorow (1992).

² I have previously suggested (Geist, 2013a, b) that the depth and curative potential of any treatment is contingent on a sensibility in which patient and therapist allow themselves to be a deeply felt presence in each other’s experiential world, what I have referred to as a sense of connectedness. A connectedness sensibility encourages us to understand the value of discerning the analytic pair, not as two separate people in the room, but as two people who experience each other as part of their respective selves, despite perceiving each other as separate people. Connectedness broadens Kohut’s conviction that the analyst’s selfobject functions are felt as part of the patient’s self-organization to a more encompassing belief that the analyst’s total responsiveness—his empathy, selfobject functions, and subjectivity—are all experienced as part of the patient’s self-organization (and vice versa).

³ Protection is not the equivalent of empathy. As Kohut once suggested, used car salesmen can be empathic; but, I would add, they certainly are not protective. We can be empathically tuned into overwhelming affect, but still leave the patient feeling unprotected from it.

⁴ This response was based on my belief, learned from Kohut (1981), that we must continually attempt to respond to a patient’s whole self rather than a fragment of that self-organization. Our discussion of baby as burden also reflects Winnicott’s (1964) understanding of the same issue.