Seven Introductory Lectures on Neuropsychoanalysis/Psychotherapy: Lecture Six, Part 1 " How to Treat the Mind" Defense Analysis

In earlier lectures I have spoken about the role of Interpretation in neuropsychoanalytic treatment. I explained the part played by both transference and extratransference interpretations. 

But we cannot always begin with these type of interpretations. Why is this the case? Because of Defense.  Part of the way our minds operate is we defend ourselves from unpleasant feelings in order not to feel them. To feel the feelings would make us too uncomfortable. So we defend ourselves from the discomfort.

When patients come to treatment because their defenses have failed them (which is most often the case), they will be feeling their unpleasant feelings. But when their feelings are adequately defended against, these defenses should be interpreted first, before transference and extratransference interpretations are attempted. Only after interpreting these defenses can one move to transference and extratransference interpretations of the unworkable, repressed, childhood prediction.

 For example, let's say you have a patient, that when he was  a young child ( 4-6 years old),  Father would scold him harshly every time he asked him to PLAY with him. And he fantasized  wanting to destroy him, kill him, or somehow remove him from the home. But he was bigger and stronger than this boy, and he could not get rid of him. He felt RAGE toward him as an unwanted obstacle getting in the way of his  meeting his PLAY need. He was also afraid, however, if he expressed his  RAGE toward his Father for being in his way, he would stop loving him or abandon you-- maybe even harm him. Thus his  PANIC/GRIEF need (which is what results when attachment needs are not met), also came into play. 

So now he had  three basic emotional needs in conflict with each other, and this conflict needed resolving (because it was causing overwhelming discomfort ). But his  little Ego  was not mature enough to come up with a good solution/prediction to the conflict. So he came up with the best prediction he could at the time, which was, " I cannot remove him and get my PLAY needs met, so I will comply with him and forgo  meeting those needs."

This was not a workable prediction, because the obstacle who stood in the way of his getting his need met was still there. But he  repressed the faulty solution (this is primary repression in Freud).  But because the prediction did not work, and the  frustrating obstacle was not removed, he was   left with the feeling of RAGE (due to prediction error ). Now his  Ego  had to call on the other  defense mechanisms to defend him against the feeling of RAGE (Freud referred to these other defenses as secondary or "after pressure" defenses.

These defenses would be either the more realistic neurotic defenses such as reaction formation and isolation of affect, or the less realistic narcissistic/borderline/psychotic defenses such as splitting, introjection, projection and disavowal. 

Let's say his Ego at this time chose the neurotic defense mechanism of reaction formation. The reaction formation caused him not to feel RAGE, but to feel its opposite, love. But  here is the most important part--his RAGE feeling did not really go away. It was still there-- just defended against.

Now as an adult your patient's RAGE is so well defended against that he finds himself unable to express RAGE at all--even when he needs to. This greatly limits his  life. So in order to "undefend" his childhood RAGE, he  needed you  his neuropsychoanalytic therapist to interpret the reaction formation defense against his RAGE-- to dismantle it, so he could feel the RAGE, learn where it came from, understand the unworkable prediction that led to it, and eventually change to a new prediction that will eliminate the need for it. 

Then, his new prediction will allow him to remove obstacles  from his life. It will say," Instead of destroying persons like my Father who get in the way of my PLAY need, I will assert myself with them and demand they stop. If they refuse, I will end my relationship with them". 

And since the new prediction works, and he has successfully removed obstacles in  his way, he no longer feels the RAGE. There is no longer any need for the RAGE, and therefore it does now indeed go away. And since there is now no RAGE, there is no need for the reaction formation defense against it.

In Modern Freudian psychoanalytic treatment this process is called Defense Analysis. As shown above, we follow a similar process in neuropsychoanalytic treatment. The difference comes in understanding the relationship of primary repression to the secondary "after pressure" defenses. Neuropsychoanalysis believes primary repression represses the unworkable childhood prediction. The other "after pressure" defense mechanisms then defend against the resultant unpleasant feeling. It is these after pressure defenses that the neuropsychoanalytic clinician must sometimes interpret first, before being able to interpret the repressed old prediction that has caused the unpleasant feeling. The repressed prediction itself then is best interpreted through transference and extratransference interpretations.

The interpreted repressed, unworkable, old prediction is then eventually replaced with the new workable prediction. But replacing the old prediction with the new one requires what psychoanalytic treatment calls "Working Through".