Defense Mechanisms

Question 1

What are defense mechanisms and when are they considered pathological?

Answer 1

Unconscious strategies to reduce anxiety by distorting or denying reality; pathological when overused and maladaptive (i.e., harms physical, mental health)

Question 2

What is transference and what factors increase its intensity?

Answer 2

Unconscious transfer of feelings and attitudes from a past person onto your clinician; intensity is increased by a vulnerable personality, rigid expectations, anxiety about safety, and frequent contact.

Question 3

What is countertransference and why is it important to recognize?

Answer 3

Clinician’s own unconscious reactions (e.g., dislike, admiration, fear) triggered by a patient or their transference; can impair judgment and care if unrecognize

Question 4

What are common physical, behavioral, and cognitive manifestations of shame in patients?

Answer 4

Physical: blushing, sweating, freezing.

Behavioral: withdrawal, breaking eye contact, nervous laughter, avoidance.

Cognitive: feeling defective, worthless, exposed.

Question 5

What 5 situations in medical settings commonly trigger shame? (ESBSJ)

Answer 5

Exposure during exams, stigmatizing diagnoses or terms, loss of bodily control, side effects, perceived judgment from clinicians.

Question 6

How can clinicians manage shame effectively (10)?

Answer 6

Ensure privacy, provide full attention, minimize delays, use respectful titles, avoid using shame as motivational tool, validate patients for seeking care, empathize with signs of shame, elicit patient perspective, collaborate on goals, suggest support groups

Question 7

What is validation in clinical practice and why is it useful?

Answer 7

Communicating that emotions make sense in context; reduces shame/ defensiveness, fosters trust, enables problem-solving.

Question 8

What are common invalidating responses to avoid? (6)

Answer 8

Counter-argument, interrogation, “should” lecturing, minimizing, premature reassurance, evasiveness.

Question 9

Give examples of validating responses to patient emotions.

Answer 9

Notice: “I can hear how worried you are.”

Normalize: “Many people feel nervous about this procedure.”

Contextualize: “Given what you’ve been through, I understand why you’d feel that way.”