Schizophrenia

Type of Mechanism

Defense Mechanisms

Definition

Example

Maladaptive

Acting out

Using actions rather than reflections or feelings during periods of emotional conflict.

A teenager gets mad at his parents and begins staying out late at night.

Adaptive

Affiliation

Turning to others for help or support (sharing problems with others without implying that someone else is responsible for them)

An individual has a fight with her spouse and turns to her best friend for emotional support.

Adaptive but can become pathological and maladaptive

Altruism

Dedicating life to meeting others (receives gratification either vicariously or from the response of others).

After being rejected by her boyfriend, a young girl joins the Peace Corps.

Maladaptive

Anticipation

Experiencing emotional reactions in advance or anticipating consequences of potential future events and considering realistic, alternative responses or solutions.

A parent cries for 3 weeks before her last child leaves for college. On the day of the separation, the parent spends the day with friends.

Maladaptive

Autistic Fantasy

Excessive daydreaming as a substitute for human relationships, more effective action or problem solving.

A young man sits in his room all day and dreams about being a rock star instead of attending a baseball game with a friend.

Adaptive

Compensation

Overemphasizing a characteristic to make up for a real or imagined failure or handicap.

I do not have time for dates, I am too busy with my ceramics.

Maladaptive

Conversions Reaction

Going to the opposite extreme to avoid carrying out an unacceptable or inappropriate impulse.

I am blind, I just suddenly went blind. The doctors can’t find out why.

Maladaptive

Denial

An attempt is made by persons to screen or ignore unacceptable realities by refusing to acknowledge them.

A woman, though told her father has metastatic cancer, continues to plan a family reunion 18 months in advance.

Maladaptive

Devaluation

Attributing exaggerated negative qualities to self or others.

A boy has been rejected by his long-time girlfriend. He tells his friends that he realizes that she is stupid and ugly.

Maladaptive

Displacement

Shifting the emotional component from one object, idea, or situation to another.

How many times have I told you to keep that bike out of the driveway!

Maladaptive

Dissociation

Experiencing a breakdown in the usually integrated functions of consciousness, memory, perceptions of self or the environment, or sensory and motor behavior.

An adult relates severe sexual abuse experienced as a child but does it without feeling. She says that the experience was as if she were outside her body watching the abuse.

Type of Mechanism

Defense Mechanisms

Definition

Example

Maladaptive

Help-rejecting Complaining

Complaining or making repetitive requests for help that disguise covert feelings of hostility or reproach towards others, which are then expressed by rejecting the suggestions, advice or help that others offer.

A college student asks a teacher for help after receiving a bad grade on a test. Every suggestion the teacher has is rejected by the student.

Adaptive

Humor

Emphasizing the amusing or ironic aspects of the conflicts or stressor.

A person makes a joke right after experiencing an embarrassing situation.

Maladaptive

Identification

Unconsciously modeling oneself after another person or group.

I have decided which shirt I want you to buy me. It’s that one.

Maladaptive

Idealization

Attributing exaggerated positive qualities to others.

An adult falls in love and fails to see the negative qualities in the other person.

Adaptive and can be maladaptive when used to often

Intellectualization

A mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded using rational explanations that remove any personal feelings or personal significance from the incident.

The hurt over a parent’s sudden death is reduced by saying “They wouldn’t have wanted to live disabled.”

Adaptive and can become maladaptive if it keeps the person from critically assessing life choices.

Introjection

Form of identification that allows for the acceptance of others’ norms and values into oneself, even when contrary to one’s previous assumptions.

A seven-year-old-boy tells his little sister, “Don’t talk to strangers.” He has introjected this value into his self from the instructions of parents and teachers.

Adaptive and can become maladaptive if suppressing emotional awareness and increase the risk of medical conditions

Isolation of affect (AKA Isolation)

Separating emotional components of a thought, which may be temporary or long term.

A second-year medical student dissects a cadaver for her anatomy course without being disturbed by thoughts of death.

Maladaptive

Omnipotence

Feeling or acting as if one possesses special powers or abilities and is superior to others.

An individual tells a friend about personal expertise in the stock market and the ability to predict the best stocks.

Maladaptive

Passive aggression

Indirectly and unassertively expressing aggression toward others. There is a façade of overt compliance masking convert resistance, resentment, or hostility.

One employee doesn’t like another, so he secretly steals her milk from the office refrigerator. She is unaware of his hostile feelings.

Maladaptive

Projection

Attributing one’s own thoughts or impulses to another as if they originated in the other person.

It’s all your fault that I did not win in the contest.

Type of Mechanism

Defense Mechanisms

Definition

Example

Maladaptive

Projection Identification

Falsely attributing to another one’s own unacceptable feelings, impulses, or thoughts. Unlike projection, the individual does not fully disavow what is projected. Instead, the person remains aware of their own affect or impulses but misattributes them as justifiable reactions to the other person. Frequently, the individual induces the very feelings in others that were first mistakenly believed to be there, making it difficult to clarify who did what to whom first.

A child is angry at a parent, who in turn becomes angry at the child but may be unsure of cause of the anger. The child then feels justified in being angry at the parent.

Maladaptive

Rationalization

Offering a socially acceptable and logical explanation for an act or decision produced by unconscious factors.

I’m going to die of something, anyway, so why quit smoking?

Maladaptive

Reaction Formation

A mechanism that allows persons to act exactly opposite to the way they feel.

An executive resents his bosses for calling in a consulting firm to make recommendations for changes in his department but verbalizes complete support of the idea and its exceedingly polite and cooperative.

Maladaptive

Regression

A return to an earlier, more primitive form of behavior.

Since Jenny has been sick, she constantly cries for her mother.

Maladaptive

Repression

The involuntary exclusion of emotionally painful material from awareness.

I can’t seem to remember my supervisor’s name.

Adaptive

Self-assertion

Expressing feelings and thoughts directly in a way that is not coercive or manipulative.

An individual reaffirms that going to a ball game is not what she wants to do.

Adaptive

Self-observation

Reflecting feelings, thoughts, motivation, and behavior and responding to them appropriately.

A person notices an irritation at his friend’s late arrival and decides to tell his friend of his irritation.

Maladaptive

Splitting

Compartmentalizing opposite affect states and failing to integrate the positive and negative qualities of the self or others into cohesive images.

One friend is wonderful and another former friend, who was at one time viewed as being perfect, is now believed to be an evil person.

Adaptive

Sublimation

Channeling potentially maladaptive feelings or impulses into socially acceptable behavior.

An adolescent boy is angry with his parents. On the football field, he tackles someone very forcefully.

Adaptive and can be maladaptive depending on how it is used

Suppression

The intentional exclusion of material from consciousness.

I’m sorry I forgot. Now that you mention it, I do recall.

Maladaptive

Undoing

An action or words designed to annul disapproved thoughts, impulses, or acts in which the person relieves guilt by making reparation.

A father spanks his child, and the next evening brings home a present for him. A teacher spent only a little time writing an exam and then curved it beyond what was usual.

Technique

Definition

Example

Offering Self

Make yourself available to the patient.

“I’ll stay with you if you would like to talk.”

Open-ended Questions

Ask neutral questions, using when, where, how, and what, that encourage the patient to discuss concerns

“What makes the pain worse?”

Broad Openings

Allow the patient to take the initiative in introducing the topic using a specific open-ended question.

“What would you like to discuss?”

Offering General Leads

General leads let the patient know you are listening, engaged in the conversation and prompt the patient to continue.

“Go on…”, “I see.”

Verbalizing the Implied

Put into words what the patient has only implied or indirectly stated.

Pt: “It’s a waste of time to talk to my doctor.” Nurse: “Are you feeling that no one understands?”

Placing an Event in Time or Sequence

Clarify the relationship of events in time to view them in perspective

“When did your symptoms become worse in relationship to beginning your exercise program?”

Encouraging Comparison

Ask the patient to compare similarities and differences in ideas, experiences, or interpersonal relationships.

“Tell me how your blood sugar levels compared to when you were on the diet and when you were not.”

Opening Remarks

Use general statements based on observations and assessments of the patient to initiate discussion.

“I noticed that you seemed sad after speaking with the doctor.”

Restatement

Repeat to the patient the various content of his or her conversation typically using the same words. Restatement communicates that the nurse is listening but it also communicates that the nurse is playing an active role. Pick out the primary thought or feeling to restate. Overuse of this technique produces a “mimic effect”.

Pt: “I’m worried about my potential disability.” Nurse: “You’re worried about your ability to function.”

Acceptance

Encouraging and receiving information in a non-judgmental and interested manner. A nurse would use this to establish trust and develop a rapport with the patient.

Patient: “I have done something terrible.” Nurse: “I would like to hear about it. It is all right to discuss this with me.”

Reflection

Identify the various emotional themes in a conversation and direct these back to the patient.

Pt: “My husband may look at me differently after the surgery.” Nurse: “You’re anxious about how this surgery may affect your relationship with your husband.”

Focusing

Guide the patient to narrow in on key concerns. Can be termed “Exploring” when delving further into a subject, idea, experience, or relationship without probing.

“You’ve told me about your support system; tell me more about who will assist you when you first get home from the hospital?”

Seeking Clarification

Assist the patient to put into words unclear thoughts or feelings. Seeking clarification decreases the potential for the nurse to guess and/or assume incorrectly. The nurse can clarify the patient’s words or can clarify assumptions about the patient’s non-verbal behaviors.

“Help me to understand your expectations of the treatment.”

Giving Information

Share with the patient relevant information about his or her healthcare and well-being. Provide patient education.

“I’m going to review the side effects of this new medication.”

Looking at Alternatives

Help the patient see options and participate in the decision-making process.

“How do you think you can best stay on your diabetic diet?”

Silence

Allow for a pause in the conversation that permits the nurse and patient time to think about what has taken place. Non-verbal behaviors can communicate caring during silence. Silence can also focus the patient and call attention to what the patient has just verbalized. Time is bought to allow the patient to reevaluate or absorb the impact of a verbalization. Silence is also used when words are not an adequate response.

(No verbalization)

Summarizing

Highlight the importance of a conversation by condensing what was said. Can be used to evaluate learning. Summarizing represents a set of feelings that might have been communicated over a period of minutes. It is a paraphrase that pulls together several feelings.

“We have reviewed the side effects of this medication; how to take it, and how to store it.”

Confrontation

Presenting the patient with a different reality of the situation. If using this a nonjudgmental attitude is imperative as this technique may alienate the patient.

Patient: “My provider won’t talk to me.” Nurse: “I was in the room yesterday when you refused to speak to the provider”

Doubt

Expressing or voicing doubt when a patient relates a situation. A nurse uses this to guide the patient towards other explanations. This is used carefully only when the nurse is certain of the facts/details.

Patient: “My best friend hates me. She never calls me.” Nurse: “From what you have told me that doesn’t sound like you friend. When did your friend last call you?”

Interpretation

Putting into words what the patient is implying or feeling. This technique is used to help the patient identify underlying thoughts.

Patient: “I could not sleep because someone would come in and rape me.” Nurse: “It sounds like you were scared last night. “

Observation

Stating to the patient what the nurse is observing. This is used to point out to the patient that their behavior and actions are unusual for the patient.

Nurse: “You are trembling and perspiring. When did this start?”

Validation

Clarifies understanding of the situation and is used when a nurse is trying to understand a situation a patient tries to describe.

Nurse: “Let me see if I understand what you are saying.”