Defense Mechanisms (From Chapter 2)

Question 1

What is the “upside” to defense mechanisms?

Answer 1

Protect the ego from mild to moderate anxiety.

Question 2

Not in text but in PPT:

Slamming books on a table, punching someone, etc?

Answer 2

Acting out

Question 3

Not in text but in PPT:

Devotion of self to serving others to manage a conflict or stress.

Answer 3

Altruism - comes form “higher level” and does not stem from anger or guilt.

Levy ppt.

Question 4

A girl is bound to a wheelchair and unable to play sports so she becomes a great scholar.

This is an example of?

Answer 4

compensation - covering up a real/perceived weakness by emphasizing a more desirable trait.

Observable behavior: perfectionism, over achievement

Question 5

A woman’s dr tells her that a lump was found in her breast. An appointment is made for a surgeon but the woman does not keep the appointment. She continues her life without concern.

This is an example of?

Answer 5

Denial

To bring the patient back to reality…
“I don’t have cancer.”
“What was the reason you originally came to the hospital?”

Question 6

You are at work and your boss really pisses you off. You chew on it all day. When you get home you kick the crap out of your dog. This is an example of?

Answer 6

displacement.

An adaptive behavior would be to acknowledge your anger, remain calm, and explore additional adaptive ways to deal with anger.

Question 7

In PPT (Defense Mech slide 61), not in text:

A person says they want to quit their teaching job to become a singer (their voice sucks).

In children,if they are having a hard time at school for example, then they might convince themselves that they are in fact spies, or have superpowers like Superman, and this can help them to deal with the situation. As an adult, it is irrational, unless used in a sexual relationship (meow!).

Answer 7

Fantasy - Gratification of frustrated desires, achievements and relationships by substituting daydreams and imagery.

If client is experiencing this, bring them back to reality. Ask about future plans and assist them to gain insight.

Question 8

A teenager required lengthy rehabilitation after an accident decides to become a physical therapist as a result of the experience…

Answer 8

identification - an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires.

A sick teenage patient is given dr coat and stethoscope and is running around the hospital instead of being treated. To help him, bring him back to reality. “Before you can become a dr, we need to treat you, you need to finish HS, go to college.” etc.

Observable behavior:mimicking others behaviors and mannerisms

Question 9

A couple walks into a therapists office to discuss their divorce. One of them begins rattling off statistics on divorce in the state of california….

A therapist was dumped by his fiancee. He shows no emotion but start to analyze her behavior and tries to reason why the relationship failed.

Answer 9

Intellectualization - overuse of abstract thinking to control/minimize painful feelings.

Ask the client how their knowledge relates to their personal situation and explore feelings.

Question 10

A child is raised in a catholic household and grows up to be a catholic adult. He never questions it.

A child sees their parent stealing from Walmart and selling the merchandise. The child does the same.

Answer 10

Introjection - adopting someone else’s values and standards as if they were your own.

Help client differentiate between self and others.

Observable behavior:Taking on values, mannerisms, illnesses, aspects of another.

Question 11

A woman describes being attached and raped without emotion.

A man is told his mother just died and he sits there with no reaction.

Answer 11

Isolation - separating thought or memory from the feeling, tone, or emotion associated with it.

Restate asking if the person understood (in the case of the mom dying). Encourage the person to express feelings.

Question 12

In PPT, not in text:

Emphasis on ironic or amusing components on a crisis, conflict, or stressor.

Answer 12

Humor

Assess appropriateness of humor in situation.

Okay to laugh at a joke, but not at a patient.

Question 13

In PPT, not in text:

A student walks in to class late on her first day of nursing school. She states, “I am a doctor in my country, I shouldn’t have to take this class.”

Answer 13

Omnipotence - feeling or acting superior to other as if one has special abilities or power.

Question 14

In PPT, not in text:

Expression of aggression towards others in an indirect or non-assertive way.

Answer 14

Passive aggressive

Covert hostility and resentment masked by over compliance.

Assist client to develop insight into their behavior and impact on others.

Observable behavior: procrastination

Question 15

Sue feels a strong sexual attraction to her track coach and tells her friend, “He’s coming onto me.”

A soldier has an extreme fear of participating in military combat tells his sergeant that the others in his unit are a bunch of cowards.

“Sorry I am late for the meeting, MY ASSISTANT forgot to remind me of the time.”

Answer 15

Projection - attributing feelings or impulses unacceptable to one’s self to another person or group. Blaming.

Provide consistent and caring approach as trust develops present reality as information.

Question 16

“I drink because it’s the only way I can deal with my bad marriage and my job.”

“It’s okay, everybody else does it.”

“I was late to work because the traffic was bad.”

Answer 16

Rationalization - use of contrived, socially acceptable and logical explanations to justify unpleasant material.

Teach client how to deal with reality and focus on their strengths.

Question 17

Janes hates nursing and only attended nursing school to please her parents, yet when she speaks at career day she tells attendees that nursing is an excellent career.

A patient has an abortion, then becomes a prolifer.

Politicians shoots down LGBT protection, but is gay.

Answer 17

Reaction formation - prevention of awareness or expression of unacceptable desires by adoption of the opposite. (Politician is not yet out or realizing he is gay).

Help patient to gain insight while respecting and supporting defenses.

Question 18

A person becomes depressed , withdraws to their room and curls u in a fetal position on the bed, sleeping for long periods of time.

A child who drank from a cup for six months becomes ill with tonsillitis. The child will only drink from a bottle now…

Answer 18

regression - returning to earlier level of adaptation.

WHen anxiety decreases, help the client examine stressor. Example, client fails test and begins sucking thumb. “WHen did you start sucking your thumb.”

Question 19

A client was in a terrible accident and remembers NOTHING about it.

A woman was sexually assaulted when she was 15 but does not recollect the event.

Answer 19

Repression - INVOLUNTARY, Unconscious process of keeping out conscious ideas or impulses that are unacceptable.

Respect this defense mechanism. Gain client trust. Ask the client what age they can start to remember.

Observable behavior: Amnesia

Question 20

A child died due to medical mistake. She dedicates her life to spreading information on how to prevent this sort of death.

Jennifer Anniston gets dumped and turns to yoga and fitness.

Answer 20

Sublimation - rechanneling drives or impulses that are personally or socially unacceptable into activities that are constructive.

Question 21

What is abreaction?

Answer 21

the expression and consequent release of a previously repressed emotion, achieved through reliving the experience that caused it (typically through hypnosis or suggestion).

Question 22

In PPT, not in text:

“You are the best nurse on this floor. Hey I notice you go to starbucks every morning, here’s some money. Why don’t you get me some, I mean you will already be there.”

“No.”

“You are the worst nurse. YOu POS, you’re just like everyone else.”

Answer 22

Splitting - idealization & devaluation; black and white; compartmentalization of opposite-affect states and failure to integrate positive and negative aspects of self or others,, resulting in polarized images of self and others as all good or all bad.

Set consistent limits, teamwork and communication, favor staff can quickly become unfavored. Be aware of manipulation.

Question 23

“I don’t want to talk about the divorce right now. There’s nothing I can do about it anyway.”

“I will deal with it later.”

Answer 23

Suppression - CONSCIOUS/VOLUNTARY, voluntary blocking of unpleasant feelings and experiences form one’s awareness (holding it in). Inhibition of an impulse, idea, or affect. Person has full awareness of the behavior.

Nurse must be direct in assessing patient’s avoidance.

Observable behavior: avoidance in discussing painful problems, wishes or feelings.

Question 24

Joe is nervous and yells at his wife. On the way home from work he buys her flowers.

Kobe cheated on his wife and bought her a gigantic diamond ring.

A man spills salt on the table, then sprinkles some over his left shoulder to “prevent bad luck.”

Answer 24

Undoing - symbolically negating or canceling out an experience that one finds intolerable. atontement for or attempt to dissipate unacceptable acts or wishes.

Observable behavior: compulsive, apologizing