Defense Mechanisms Master Class PDF

Defense Mechanisms Master Class David Montero MD, Psychotherapist  Objectives Understand the unconscious, preconscious, and conscious according to topographic theory. Differentiate between ego, id, and superego, according to the structural theory....

Defense Mechanisms Master Class David Montero MD, Psychotherapist  Objectives Understand the unconscious, preconscious, and conscious according to topographic theory. Differentiate between ego, id, and superego, according to the structural theory. Identify pathological, immature, neurotic, and mature defense mechanisms. Explain transference and countertransference reactions. Apply knowledge of defense mechanisms to analyze case studies, identifying the types of defenses. Describe the characteristics of the treatment used (psychoanalysis and psychodynamic therapy). Freud’s topographic theory of the mind In the topographic theory, the mind contains THREE LEVELS: The UNCONSCIOUS, PRECONSCIOUS, and CONSCIOUS. 1. The unconscious mind contains repressed thoughts and feelings that are not available to the conscious mind and uses primary process thinking. The primary process is a type of thinking associated with primitive drives, wish fulfillment, and pleasure-seeking and has no logic or concept of time. Primary process thinking is seen in young children and psychotic adults. b. Dreams represent gratification of unconscious instinctive impulses and wish fulfillment.  Freud’s topographic theory of the mind 2. The preconscious mind contains memories that, while not immediately available, can be accessed easily.  Freud’s topographic theory of the mind 3. The conscious mind contains thoughts that a person is currently aware of. It operates in close conjunction with the preconscious mind but does not have access to the unconscious mind. The conscious mind uses secondary process thinking (logical, mature, time-oriented) and can delay gratification.  Freud’s Structural Theory of the Mind Structural Topographic Age at Which Characteristics Component Level It of Operation Develops Id Unconscious Present at Contains instinctive sexual and aggressive drives birth Controlled by primary process thinking Not influenced by external reality Ego Unconscious, Begins to Controls the expression of the id to adapt to the requirements of preconscious, develop the external world primarily using defense mechanisms and conscious immediately after Enables one to sustain satisfying interpersonal relationships birth Through reality testing (i.e., constantly evaluating what is valid and then adapting to that reality), enables one to maintain a sense of reality about the body and the external world Superego Unconscious, Begins to Associated with moral values and conscience preconscious, develop at Controls the expression of the id and conscious about 6 years of age  Are unconscious mental processes used by the ego to keep Defense Mechanisms conflicts out of the conscious mind, thus decreasing anxiety and maintaining a person’s sense of safety, equilibrium, and self-esteem. They can be useful in helping people deal with difficult life situations such as medical illness, but when used in excess, they can become a barrier to seeking care or adhering to treatment recommendations. The study of defense mechanisms was first explored by Sigmund Freud and later expanded by his daughter Anna in the 20th century. Since then, the understanding of defense mechanisms has grown, with later psychoanalysts, psychiatrists, and psychodynamic therapists contributing to an increased number of recognized mechanisms. Anna Freud founder of child psychoanalysis contributed ego psychology and defense mechanisms. Sigmund Freud Father of Psychoanalysis  Defense Mechanisms Defenses change over time. (as we age). We are only aware of our defenses in retrospect. Defenses are adaptive as well as pathologic. Everybody uses defense mechanisms but may or may not be dependent on them. Think of them as the immune system of the mind. Some authors may vary on the classification of each defense mechanism. Excessive use of defense mechanisms is seen in personality disorders.  Narcissistic-Psychotic Defense Mechanisms Also known by some authors as “pathological”. This level includes defense mechanisms that are considered Narcissistic - Psychotic maladaptive and indicative of severe psychological disturbances. Defense Mechanisms Are based on negating, or distorting reality, and are commonly found in: Splitting Projection Young children. Adult dreams/fantasies. Denial Distortion Or as part of psychotic processes involving impaired functioning.  Defense Mechanism: Denial Psychotic Defense Mechanism Example: A man who has a problem with alcohol insists that he is only not an alcoholic, despite drinking at work. Not accepting aspects of reality that the person finds unbearable. Example: A patient does not take the medication because he Avoiding anxiety-provoking thoughts by not accepting reality insists, he does not have a disorder or disease. Common early response to bad news Example: A wife denies her partner is cheating on her despite Associated with substance use disorder having the evidence to prove otherwise. Example: Upon hearing the news of his spouse’s death, she denies the reality and insists that there must be a mistake  Example: Sarah idolizes her coworker John, viewing him as Defense Mechanism: Splitting perfect and talented. However, upon noticing a mistake, she shifts to seeing him as incompetent and unreliable, disregarding his positive qualities and devaluing him. Psychotic Defense Mechanism Then he treats her well and she idolizes him again. Categorizing people or situations into categories of either “ all good or all bad” (black or white) because of intolerance of ambiguity. Seen in patients with borderline personality disorder.  Defense Mechanism: Distortion Example: A woman tells a story about how she was abandoned Psychotic Defense Mechanism by her family when she actually ran away from home. Altered perception of external reality (e.g., hallucinations, wish-fulfilling delusions) to SUIT INNER NEEDS TO SUSTAIN SUPERIORITY/ENTITLEMENT (Delusion involves a person believing something to be true when it is not.)  Defense Mechanism: Projection Psychotic Defense Mechanism Attributing one’s own personally unacceptable feelings to Example: A man with unconscious homosexual impulses begins to others. believe that a male colleague is attracted to him. Example: A man who wants to cheat on his wife accuses his wife of (Personal conflicts or insecurities about one's are projected onto others through statements or actions) being unfaithful. Example: A man who has committed adultery becomes convinced Associated with paranoid symptoms and prejudice. that his wife is having an affair even though there is no evidence of it. In patients with paranoid personality disorder, may include Example: A girl talks about her doll as having certain feelings, which paranoid delusions, and acting on these perceptions are really what the girl feels. (Paranoia results from the use of projection) Example: A physician believes that the nursing staff is uncomfortable talking to him, when in fact, he is uncomfortable talking with them. Immature Defense Mechanisms Immature Defense Mechanisms These mechanisms are considered less adaptive and may lead to more negative consequences in the long term. Acting Out Regression Primitive Idealization These mechanisms flourish in situations (and minds) where emotion trumps reason and impulsivity rules. Blocking Hypochondriasis Identification Children use them naturally and normally, but then again, children are emotionally immature and not held to a higher standard as adults are. Passive Somatization Undoing Aggression When adults use these methods regularly, it is an indication that their emotional development is at some level delayed. Fixation Fantasy They are manifestations of child-like or disturbed behavior  Fixation & Freud Sexual Developmental Stages Is not a defense mechanism per se, however, it contributes to the development of various defense mechanisms. Some authors consider it an Immature Defense. The patient “Fixes” at a psychosexual developmental stage. Freud used the term fixation to refer to the continued use of pleasure-seeking or anxiety-reducing behaviors appropriate to an earlier stage of development. https://articles.outlier.org/what-are-sigmund-freuds-theories-an-explainer Fixation Oral Stage (0-1 years): Oral fixation may occur if a child's needs during this stage are not adequately met, leading to a preoccupation with oral activities. Example: An individual with an oral fixation may engage in habits like thumb- sucking, nail-biting, smoking, or overeating. Anal Stage (1-3 years): Anal fixation may occur if a child experiences harsh potty-training methods or excessive emphasis on cleanliness during this stage. Example: An individual with an anal fixation may exhibit characteristics of being overly neat, orderly, and controlling, or conversely, they may be messy and disorganized. Phallic Stage (3-6 years): Phallic fixation may occur if a child experiences unresolved conflicts or trauma related to sexual identity or desire for the opposite-sex parent during this stage. Example: An individual with a phallic fixation may exhibit behaviors such as flirtatiousness, vanity, exhibitionism, or excessive jealousy and rivalry.  Genital Stage (puberty-adulthood): Fixation Latency (Hidden) Stage (6-puberty): The person’s concern shifts from primary-drive gratification In the latency stage, fixation is less common since sexual impulses (instinct) to applying secondary process-thinking in order to are repressed, and libido is focused on developing social and gratify desires symbolically and intellectually by means of cognitive skills. friendships, a love relationship, or family and adult responsibilities. (The child now begins to act on their impulses indirectly by focusing on activities such as school, sports, and building If fixation occurs at this stage it will lead to frigidity, impotence, relationships) and unsatisfactory relationships. Freud did not identify any erogenous zone for this stage. If fixation were to occur, it might manifest with difficulties in forming close relationships, feelings of inadequacy, insecurity, and social isolation in adulthood.) It's important to note that fixation is a theoretical concept in Freudian psychoanalysis and is not universally accepted in modern psychology. While Freud's stages provide a framework for understanding personality development, they are considered controversial and have been criticized for their lack of empirical evidence and reliance on unconscious processes.  Defense Mechanism: Regression Immature Defense Mechanism Example: A previously toilet-trained child begins to wet the bed again after the birth of a new sibling. Involuntary return to a childlike state or prior maturational stage to avoid the stress evoked at the Example: A child who stopped sucking their thumb begins to present level of development do so again after being hospitalized for an upcoming surgery. Associated with dependent personality disorder Patient develops enuresis  Defense Mechanism: Blocking Example: An individual is unable to answer a question during an Immature Defense Mechanism exam but immediately recalls it once the exam is over. Temporarily or transiently inhibited thinking when feeling increased levels of Example: A child is unable to spell a word in the finals of a spelling stress bee contest, then recalls it when the contest is over. Commonly manifests when the affected individual is experiencing embarrassment  Defense Mechanism: Acting Out Immature Defense Mechanism Example: An employee yells and throws things from his desk Avoiding personally unacceptable emotions by behaving in an in response to the news of being fired from his job. attention-getting, often socially inappropriate manner. Expressing unacceptable or extreme feelings and thoughts Example: A 17-year-old girl cuts her wrists to get help through action unconsciously because she does not know how to Associated with borderline and antisocial personality disorders communicate her needs effectively.  Defense Mechanism: Somatization Immature Defense Mechanism Example: A medical student develops headaches during a Converting psychological problems into stressful board exam. real bodily symptoms May be associated with somatic symptom disorders  Defense Mechanism: Hypochondriasis Immature Defense Mechanism Exaggerating or overemphasizing an illness to Example: A woman with mild abdominal cramps claims to be bedridden avoid responsibility or guilt associated with when nobody calls her on her birthday. loneliness, bereavement, or aggressive impulses Common in individuals with anxiety disorders and/or a history of traumatic clinical experiences  Defense Mechanism: Idealization Immature Defense Mechanism Imposing more positive qualities on an external object or person than they actually have while Example: A female partner brags on social media about his ignoring their negative features “perfect” husband’s accomplishments while ignoring any of Common in individuals with personality disorders his flaws. (He is an unfaithful & violent husband) Example: A woman believes that her new boyfriend is absolutely flawless.  Defense mechanism: Fantasy Immature Defense Mechanism Example: An elderly man in a wheelchair repeatedly Withdrawal into fantasy to resolve inner and/or outer suggests to his grandson that they race one another on foot. conflicts. Distortion of unconscious feelings or wishes. Example: a boy who is being bullied by his classmates A temporary escape from the "real world" wishes he had the power of a warrior. Daydreams may be a substitute for what a person is unable to accomplish in reality. Example: A student struggling through medical school thinks May be associated with stressful situations and personal about a high-paying job he wishes to endure the struggle crises. unconsciously.  Defense Mechanism: Passive Aggression Immature Defense Mechanism Example: Alice and Betty are roommates, and Alice is bothered by Betty's habit of leaving dirty dishes in the sink. Demonstrating hostile feelings in a Whenever Betty leaves dirty dishes, Alice cleans them but makes sarcastic nonconfrontational manner; showing indirect remarks like, "Looks like someone forgot to do their dishes again" opposition. Common in children and individuals with BPD  Defense Mechanism: Identification (Introjection) Immature Defense Mechanism Identification with the aggressor. The unconscious modeling of one's behavior, characteristics, Example: A boy who was abused by his father becomes an qualities, or traits, whether good or bad, on those of another abusive parent person Example: A traumatized medical student adopts punitive behaviors towards lower semester students, replicating the This process can involve emulating someone perceived as authoritarian approach of her clinical instructor powerful, confident, or admirable to feel more secure or accepted. May be associated with anxiety disorders Identification: Example: A young girl begins to dress more and more like her revered older cousin, without realizing it. Example: A girl who lacks confidence singing in public adopts traits and behaviors of a charismatic public figure she admires. This emulation helps to cope boosting her self-esteem by attempting to embody the confident persona of the admired individual. However, while this identification provides temporary relief, it doesn't address the underlying issues of self- confidence and personal growth.  Defense Mechanism: Undoing Immature Defense Mechanism Example: A woman who stole money from a friend, confesses to Believing that one can magically reverse past events caused by “incorrect” behavior by now adopting “correct” behavior, the theft, returns the money, and then feels compelled to offer to e.g., atonement, confession, or penance. drive the friend to and from work for a year. Trying to avoid guilt about negative thoughts or actions by engaging in the opposite behavior. Example: Excessively praising someone after having insulted An action which carries out a certain injunction is immediately them. succeeded by another action which stops or undoes the first one even if it does not go quite so far as to carry out its Example: An individual with OCD has frequent and distressing opposite. thoughts about germ contamination and washes their hands Seen in obsessive-compulsive disorder until they're raw or bleeding. Example: A person who feels guilty about gossiping confesses their actions during a religious confession, seeking forgiveness and committing to avoid such behavior in the future. Neurotic Defense Mechanisms Are intermediate-level defense mechanisms defined by a more ambivalent relationship with reality. Reality is recognized here to a larger extent, even if it is put off or avoided. These mechanisms fall between immature and mature defenses in terms of complexity and adaptiveness. So, they are harder to spot to the naïve clinician, due to their complex nature. They are often seen in individuals with neurotic tendencies or unresolved emotional conflicts. Neurotic Defense Mechanisms Controlling Externalization Repression Inhibition Displacement Dissociation Sexualization Intellectualization Isolation of affect Rationalization Reaction formation  Defense Mechanism: Controlling Neurotic Defense Mechanism Excessively attempting to manage or regulate Example: A mother does not let her child attend a the environment (i.e., objects or people) to friend's birthday party unless she can influence who else minimize anxiety will attend it. May be associated with OCD or anxiety disorders  Defense Mechanism: Externalization Neurotic Defense Mechanism Example: A man perceives his partner as aggressive and himself as peaceful, although he is the aggressor. Externalization is known as a variation of Projection. (Externalization is broader.) Example: A mother blames her son for preventing her from having friendships, although she chooses to spend all her time with her son. Perceiving one's own personality in the external world and external elements (including instinctual impulses, conflicts, Example: an overly argumentative patient might instead perceive moods, attitudes, and styles of thinking) others as argumentative and himself as blameless. In Externalization, you blame others for your problems Example: A person who habitually shifts blame onto external factors rather than owning up to any role you may play in like traffic, weather, or others, rather than taking responsibility for its causing them. (Blaming others for the way one treats own mistakes or failures. themself) For example, if they're late for work, they'd blame traffic or a slow bus Externalization involves creating or finding a reality to instead of admitting to oversleeping or poor time management. support the defenses, including projecting. (Involves attributing personal shortcomings or responsibilities to external circumstances.) May be associated with ADHD or substance use disorders.  Defense Mechanism: Repression Neurotic Defense Mechanism Repression, pushing unacceptable emotions into the Example: An adult suffers a drowning experience as a child and unconscious, is the basic defense mechanism on which develops an intense fear of swimming later in life, with no memory of all others are based. the childhood experience. Thoughts are unconsciously removed from conscious awareness. Certain facts that were known and accepted at some point in life become absent from memory Some contents can appear in the dreams of the patient even if it does not remember consciously. “I forgot that I forgot”  Defense Mechanism: Inhibition Neurotic Defense Mechanism Consciously limiting ego functions, alone or in combination, to avoid anxiety arising out of conflict Psychoanalytic theory views inhibition as a largely unconscious mechanism that mediates between the superego (the moral conscience) and the id (primitive desires). The unconscious restraining of an instinctual process. Taboos, such as those against incest or murder, are those socially imposed inhibitions that are raised to the level of unwritten laws. (This means the mechanism forbids the expression of a wish or a natural capacity because it would clash with the superego unconsciously) Some inhibitions represent a relinquishment of a function because its exercise would produce anxiety May be associated with anxiety disorders Example: A parent is unable to discipline a disobedient child out of fear of making them angry. Example: A young man forbids any thoughts of lust about his female cousin, believing it is improper to feel that way about a family member..  Defense Mechanism: Displacement Example: A surgeon with unacknowledged anger toward his sister is abrasive to the female residents on his service. Neurotic Defense Mechanism Redirection of emotions or impulses to a less threating or Example: After being reprimanded by his boss, a frustrated neutral person or object. worker returns home and criticizes her wife’s cooking instead of confronting the boss directly. Example: A mother demonstrates feelings of anger towards her child instead of her husband, who is the actual source of her frustration.  Defense Mechanism: Dissociation Example: Following a violent altercation, John feels Neurotic Defense Mechanism disconnected from his surroundings, as if observing from afar. Mentally separating part of one’s consciousness from real- life events or mentally distancing oneself from others. Example: A survivor of sexual abuse sees the abuser and suddenly becomes numb and detached. Temporary, drastic change in personality, memory, consciousness, or motor behavior to avoid emotional stress. The patient has incomplete or no memory of the traumatic event. Depersonalization Derealization Sucker Punch (2011 film)  Defense Mechanism: Sexualization Neurotic Defense Mechanism Endowing an object, person, or function with sexual significance Sexualization of a person is usually linked to sexual objectification of that individual. Alternatively, sexualization can refer to the development of specific fetishes or sexual references to conventionally non-sexual entities. Example: A woman evaluates her partner based on their sexual significance only, excluding other characteristics.  Defense Mechanism: Intellectualization Neurotic Defense Mechanism Example: A medical doctor diagnosed with cancer discusses the Using facts and logic to emotionally distance pathophysiology of the disease. oneself from a stressful situation Common response to emotional stress Example: A young man is going through a divorce and begins to contemplate how he will move the furniture out of the house  Defense Mechanism: Isolation of affect Example: A young man recalls traumatic events without showing Neurotic Defense Mechanism any emotions such as they day his house burnt. Failing to experience the feelings associated with a stressful life event, although logically understanding the significance of the event. Example: Describing murder in graphic detail with no emotional Accepting reality without the accompanying emotional response response. Common response to emotional stress or a traumatic event  Defense Mechanism: Rationalization Neurotic Defense Mechanism Example: Robin Hood rationalizes his actions of stealing from the rich by framing them as necessary for the greater Distorting one’s perception of an event so that its negative outcome seems reasonable. good and to address social inequality. Asserting plausible explanations for events that Example: A student claims that she failed a grade because all actually occurred for other reasons, usually to avoid her teachers dislike her, instead of admitting that she has not self-blame studied all year. Common in OCD  Defense Mechanism: Reaction Formation Neurotic Defense Mechanism Example: A homosexual individual is highly critical of same-sex Also known as “unconscious hypocrisy” couples. An individual unconsciously behaves in a way that is opposite to their true feelings or desires. This mechanism involves expressing exaggerated attitudes or behaviors that are contrary to their actual thoughts or emotions. The purpose of reaction formation is to manage or cope with unacceptable or anxiety-inducing feelings by adopting an opposite stance or attitude. Mature Defense Mechanisms These mechanisms are considered more adaptive and constructive in managing anxiety and emotional conflicts. They promote healthy coping strategies and personal growth. Examples include sublimation, altruism, suppression, humor, and anticipation. Mature Defense Mechanisms Sublimation Humor Altruism Anticipation Suppression Mnemonic: SASHA is a mature adult  Defense Mechanism: Suppression Mature Defense Mechanism Deliberately pushing personally unacceptable emotions out Example: of conscious awareness Facing unexpected complications during surgery, a surgeon suppresses Includes some aspect of consciousness. (consciously) anxiety and fear, maintaining focus and composure to ensure a successful outcome. “I need to focus on the surgery and not on my problems at this time, because I need to focus on saving the life of my patient.” “I will forget the fear and worry and will focus on saving my patient” “I forgot, but I remember that I forgot something”  Defense Mechanism: Humor Mature Defense Mechanism Example: A man who is concerned about his erectile problems Using comedy to express feelings and thoughts to lessen makes jokes about Viagra (sildenafil citrate) personal discomfort and avoid emotional Example: A new employee expresses a serious situation in the distress without producing an unpleasant effect on others form of a joke.  Defense Mechanism: Anticipation Example: An A-student goes over course notes in preparation for a Realistic planning or premature worrying about lecture the following morning. future discomforts Using anticipation allows the individual to mitigate the effects of future stressors or conflicts. Example: This defense mechanism may be present in someone It requires being able to tolerate the anxiety who prepares for an important job interview by practicing their attendant to imagining how a future situation may be answers to the toughest questions. distressing. The devotion of one’s effort to solving problems before they arise. Associated with goal-directed behavior  Defense Mechanism: Altruism Mature Defense Mechanism Example: A philanthropist who deeply values education and recognizes Altruism involves finding fulfillment and satisfaction by helping others and contributing to their well-being. the financial burden of student loans on individuals and schools decides to anonymously pay off the entire student loan debt of a struggling school Example: A Medical Doctor on his way home witnessed an accident in the street and decided to dedicate time and effort to intervene with life- saving maneuvers to save the person without expecting money or anything in return.  Defense Mechanism: Sublimation Example: A person who has experienced significant emotional pain and Mature Defense Mechanism turmoil in life channels emotions into creating powerful and moving Expressing a personally unacceptable feeling (e.g., rage) in pieces of art. Through painting, sculpting, or writing, expresses inner a socially useful way struggles and transforms pain into meaningful and impactful works of art. Example: A man who got into fights as a teenager becomes a professional wrestler prizefighter. Vincent van Gogh was born in 1853 and died in 1890. The Dutch painter voluntarily entered the Saint-Paul-de-Mausole asylum in 1889 due to mental health problems and produced several artworks while he was staying in the facility. The Starry Night, 1889, one of his most famous Example: A patient with artworks, was inspired by a landscape situated near the asylum. exhibitionist fantasies becomes a stripper.  Sublimation (in Health Sciences) A child who lost their family in a car accident in infancy grows up to become a renowned thanatologist in adulthood. An adolescent who lost his grandfather to dementia becomes a successful geriatrician in adulthood. A child who lost his father to a heart attack becomes an esteemed cardiologist as an adult. A child who struggles with emotional challenges becomes a distinguished psychotherapist/psychiatrist in adulthood. An adolescent who lost his mother to cancer grows up to become an acclaimed oncologist. An adult who experienced constant sickness as a child specializes in pediatrics. A child who had a sister with a genetic defect specializes in Genetics as an adult. A child whose younger brother suffers from seizures becomes a neurologist in the future. A woman who suffered eclampsia during her pregnancy becomes a famed OBGYN. A child who witnessed his grandparents suffering from COVID-19 grows up to become an illustrious Internal Medicine specialist. A child who saw their family members suffer from medical illness becomes a prestigious Medical Doctor specializing in family medicine. Transference Transference, a concept introduced by Sigmund Freud in psychoanalysis. Involves the unconscious redirection of emotions and attitudes from one person to another, particularly from the patient to the therapist. It plays a key role in therapy by offering insights into the patient’s inner emotions and past relationships. Transference can involve a variety of feelings, such as love, admiration, anger, or hostility, as patients often perceive the therapist as an authority figure or a stand-in for someone significant from their past.  Transference There are different types of transference, including positive, negative, and erotic. Positive transference occurs when the patient develops feelings of love, admiration, or respect for the therapist. Negative transference occurs when the patient develops feelings of anger, hostility, or resentment towards the therapist. Erotic transference occurs when the patient develops sexual feelings towards the therapist. Example: a patient who had a difficult relationship with their father may project their feelings of anger or resentment towards the therapist, who is perceived as a father figure. Erotic Positive Negative Countertransference Countertransference refers to the therapist's emotional response to the patient, often triggered by the patient's transference. It can be positive, negative, or erotic. Positive countertransference occurs when the therapist feels a strong emotional connection to the patient, which can improve the therapeutic relationship and support the patient's progress. Negative countertransference involves feelings like anger, irritation, or disgust, which can harm the therapeutic relationship and hinder the patient's progress in therapy. Erotic transference occurs when the therapist develops sexual feelings towards the patient. Due to the inethical nature of erotic transference the therapist needs to refer to the patient to another therapist as the process won't be therapeutic anymore. The therapist needs to identify in its own therapy about why the erotic transference occurred in the first place. Countertransference Countertransference can stem from the therapist's unresolved issues, the patient's transference, or personal biases like cultural or religious beliefs, leading to emotional reactions that affect interactions with the patient. Therapists need to manage countertransference by recognizing it, seeking supervision, and maintaining professional boundaries. Awareness of countertransference is essential for ethical and effective therapy. Psychoanalysis: The Talking Cure Psychoanalysis is an in-depth therapy that explores unconscious thoughts, emotions, memories, and conflicts. Sessions are frequent and long-term, spanning multiple times per week for several years to delve into unconscious material deeply with the patient on a Divan and conducted by a therapist who is a certified psychoanalyst. Techniques like free association, dream analysis, transference analysis, and interpretation are used to promote insight and self-awareness. The primary goal is deep self-exploration, gaining insight into unconscious conflicts, and fostering lasting personality change and psychological growth. In free association, patients are invited to relate whatever comes into their minds during the analytic session, and not to censor their thoughts. allowing the patient to discuss thoughts, dreams, memories, or words, regardless of coherency. Freud believed this non-linear way of thinking would lead to the unconscious mind. Psychodynamic Psychotherapy Psychodynamic therapy, based on psychoanalytic theory, evolved from psychoanalytic therapy. It is a focused, time-limited approach that explores unconscious processes while prioritizing current issues and interpersonal dynamics. Sessions occur once or twice a week over several months to a year, focusing on relational patterns, emotions, and problem- solving. The therapist, trained in psychoanalysis or psychodynamic therapy, may not be a certified psychoanalyst. The goal is to address symptoms, improve relationships, enhance self-awareness, and promote psychological well- being within a shorter time frame.  If you wish to apply your newly obtained knowledge, watch these movies Prendimi l'anima (The Soul Keeper) 2002. English Dubbed A Dangerous Method 2011. English Dubbed Focused on Sabina Spielrein Focused on Jung See this one 2nd. & Freud See this one 1st. References Le, T., Bhushan, V., Qiu, C., Chalise, A., & Kaparaliotis, P. (2023). Psychiatry. In First Aid for the USMLE Step 1 2023 (pp. 572-573). McGraw-Hill Education. AMBOSS. (n.d.). Defense mechanisms. Retrieved from https://next.amboss.com/us/article/PN0WYg?q=psychotherapy+and+defense+mechanisms Fadem, B. (2020). Psychoanalytic theory & defense mechanisms. In Boards Review Series: Behavioral Sciences 8th Edition (pp. 57-60). Wolters Kluwer.