Reflection upon barriers to experiencing, accepting and resolving emotions

There is some controversy and discussion about the definition, name and use of uninten-tional or unconscious barriers to experiencing, accepting and resolving the reality of emotions (Blackman 2004, Cramer 2000, 2005, 2006, Egan 2010, Hentschel et al 2004).

There is also a long-standing argument about the reality of the effects and role of the unconscious in determining behaviour. The concept of an unconscious mind with power to influence behaviour can cause discomfort and thus some people prefer to avoid discus-sion about the possible role of a subconscious in everyday life (Murray et al 2009). The idea that there are ‘invisible’ processes affecting an individual is unnerving; however, cur-rently psychologists do suggest that there are mental processes occurring outside the awareness of the individual that affect behaviour (Murphy 2001). Some of these processes are called defences or defence mechanisms.

Defenses (American Psychiatric Association 1994), adaptive mental mechanisms (Vail-lant 2000) or defence mechanisms assist the individual to unconsciously avoid uncomfort-able emotions, thoughts, information or desires by removing them from the conscious mind. They are a method of managing otherwise unmanageable thoughts and emotions (Giroux Bruce et al 2002). Every individual unconsciously uses defences to avoid experienc-ing negative or anxiety-provokexperienc-ing emotions. Some defences are a form of deception (Smith 2004); they allow the individual to continue behaving in a particular way regardless of the outcome of that behaviour. Others are simply ways of ‘coping with life’ at a particular time;

they maintain self-esteem and self-respect and, as such, are successful coping mechanisms that encourage mature functioning. Overuse of defence mechanisms, however, limits

•

Do you regularly and deliberately use humour?

•

Do you use humour successfully?

•

What contributes to the successful use of humour?

•

Do you use humour to:

 diffuse tension

 avoid negative emotions

 help people relax?

•

If you habitually use humour for one of the above, why do you do this?

•

Does the above answer indicate you need to learn to manage tension and/or negative emotions? What might you do about this?

self-awareness and awareness of negative emotions, restricts the harmony within the individual, and limits personal development and change (Egan 2010).

Defenses can be important for survival in particular situations – they may allow a person to continue func-tioning in extremely difficult circumstances (Murray et al 2009). Continual use of defence mechanisms by individuals will, however, habitually disconnect them from reality, sometimes distort reality and limit their ability to achieve effective communication. Over-reliance on particular defences reduces the ability to

consider and choose appropriate options or responses during difficult interactions. Recog-nition of the habitual use of particular defences allows an individual to understand their behaviour and facilitates the exercise of choice and control during difficult interactions.

While description and categorisation of defences has occurred for many years, there is a suggestion that a continuum of maturity influences the use of defences (Cramer 2000). The ability of the individual to function as a mature adult indicates the use of the mature defences. These include altruism, sublimation, suppression, anticipation and humour, and are temporary, adult ways of managing particular emotions that are essential to positive mental health (Vaillant 2000). Children often demonstrate use of the imma-ture defences, which are childish ways of managing negative emotions. These include projection, fantasy, hypochondriasis, passive aggression and acting out. The use of imma-ture defences typically decreases as people develop into adulthood. The movement along the continuum usually indicates less self-deception.

Consistent and prolonged use of defences typical of immature functioning is the cause of maladaptive behaviour, and the individual may demonstrate psychotic disturbances (Giroux Bruce et al 2002). While this is true from one perspective, from another it seems problematic because it suggests that only maladjusted individuals

employ defences from the immature end of the contin-uum. This is not necessarily true. For example, individuals experiencing grief may use denial for a time to facilitate adjustment and acceptance. While coping with grief does not usually require prolonged use of denial, denial in the short term is an important defence for many individuals and does not demonstrate maladaptive behaviour or psy-chotic disturbance. The neurotic defences – displace-ment, isolation of affect (intellectualisation), repression and reaction formation – usually require relatively less self-deception than the immature and psychotic defences, and may be used in times of stress.

The commonly used defences and their definitions are outlined in Table 5.1.

Every individual uses defences in some form at some time to continue functioning in life (Milliken & Hon-eycutt 2004). However habitual use of the defences causes maladaptive behaviour. Individuals who demon-strate obvious maladaptive behaviour (i.e. some forms of psychosis) usually employ either psychotic or imma-ture defences.

•

Consider individually each of the commonly used defences. List behaviours that indicate use of each.

Can you think of someone you know who regularly uses any of these?

How do you recognise these defences? Can you explain their use?

•

Consider those defences you have used in life. Why did you use those defences? Why did you stop using them?

•

If you still use defences, how will this affect your communication as a health professional? Do you need to seek assistance from a psychologist or counsellor to reduce the use of defences that block your ability to experience, accept and resolve particular emotions?

•

List reasons why health

professionals should be aware of commonly used defences (defence mechanisms).

•

Discuss possible reasons why health professionals should be aware of their habitual use of defence mechanisms.

COMMUNICATION: CORE INTERPERSONAL SKILLS FOR HEALTH PROFESSIONALS

Adapted from Vaillant 1995, p 36.

TABLE 5.1

Commonly used defence mechanisms Category Defence

mechanism Description

Psychotic Denial The person refuses to accept the truth about something (e.g. refuses to believe particular news).

Immature Projection Unacceptable feelings, thoughts and inadequacies, unwanted characteristics and inappropriate desires are attributed to another person (e.g. I am unconsciously angry with you, but I convince myself you are angry with me – that it is your fault, not my emotion). Such individuals always blame others for uncomfortable situations.

Fantasy The person ignores the real world and retreats into an imaginary world that fulfils the needs that reality has not met. The fantasy relieves the discomfort of life. The individual does not usually insist on or act on the fantasy.

Children may have a special imaginary friend.

Neurotic Displacement Strong feelings about one person are unhealthily redirected onto another (e.g. after a disagreement with a supervisor, the person goes home and shouts at their roommate or kicks the dog).

Repression Painful or anxious memories are forced into the unconscious. This usually occurs during childhood.

Repression has a powerful influence on behaviour and is often very destructive.

Reaction

formation Conscious thoughts and emotions are the opposite of the actual unconscious wishes and emotions (e.g. the person really likes another person but consciously thinks they do not like them).

Isolation of affect

(intellectualisation) Intellectual processes are used excessively in order to avoid uncomfortable emotions. The person may focus on details to avoid emotions (e.g. intellectualisation allows someone to organise a funeral without being

overwhelmed by emotion).

Mature Sublimation Unacceptable impulses are rechannelled into personally and socially acceptable channels (e.g. aggressive impulses are channelled into a game of squash).

Suppression The person makes a semiconscious decision to ignore a thought, idea or wish momentarily. They return to it later.

Humour This subtle and elegant defence occurs when least expected and permits the expression of emotions without discomfort or paralysis. It does not deny pain or seriousness – it simply allows expression and improves life.

Consideration of the defences individuals regularly employ can assist the health profes-sional or the Person/s to overcome barriers to experiencing particular emotions, thereby facilitating change in thoughts and actions, and thus in practice. Awareness of defences can empower individuals to ‘face’ the reality of their situation and negotiate required changes in the use of defences and thus in behaviour. With such awareness health professionals can learn to appropriately manage both expected and unexpected difficult situations in order to communicate effectively and provide consistent family/Person-centred practice.

Chapter summary

Reflection promotes awareness of unconscious emotional processes. It considers these

‘invisible’ or unconscious processes and their negative effect on interactions, and can result in resolution of the emotions producing these processes. Reflection can facilitate transformation of the thoughts and actions of the health professional to achieve effective communication and positive outcomes in practice. It should involve reflexivity: examining the self and personal responses to events and experiences. The use of a model of reflection can guide reflection to achieve increased self-awareness and control. Such models suggest describing the events during the interaction, identifying the intentions of the people interacting, considering the factors (person and environment-related factors) contributing to the responses during the interaction along with the reasons for the responses during the interaction, and the resultant feelings about the interaction. It also encourages iden-tification of ways to change any negative responses during similar interactions in the future. Reflection requires commitment, allocation of regular time to reflect and honest consideration of the causes of any negative results of a communicative interaction. It is important that health professionals consider how and when they use humour when relating.

It is also important for health professionals to be aware of their personal barriers (defences) to identifying, accepting and resolving uncomfortable emotions. There four types of defences are psychotic, immature, neurotic and mature. Everyone uses defences during their life. Some defences demonstrate a disconnection with reality, while others demonstrate more mature management of life events. Knowledge of the defences and their use can promote effective communication and positive results from interactions with health professionals.

FIGURE 5.2

Reflection can identify areas that require changing.

COMMUNICATION: CORE INTERPERSONAL SKILLS FOR HEALTH PROFESSIONALS

REVIEW QUESTIONS

1. What is reflexive practice?

_____________________________________________________________

2. Reflection is thoughtful exploration and consideration of the _______________ of events and _______________ during events.

3. Reflection achieves ten possible outcomes – list at least eight of these.

ii.

iii.

iv.

vi.

vii.

viii.

4. What is the purpose of a model of reflection?

_____________________________________________________________

5. What do most models of reflection encourage?

_____________________________________________________________

6. What five actions are beneficial when reflecting regardless of the particular model of reflection?

ii.

61 iii.

iv.

7. What does reflection encourage when considering future events within interactions?

_____________________________________________________________

8. Reflection requires commitment and time, and perhaps a journal, a glass of your favourite drink and a good honest friend to join in the journey of self-awareness, acceptance and respect. Devise a plan or strategy that will encourage and develop your skills in reflection.

_____________________________________________________________

9. In everyday language, state a definition of defences.

_____________________________________________________________

10. State three reasons why everyone uses defences.

ii.

iii.

11. Defences include the following four categories (Vaillant 1995, p 36). When might they be seen?

i. Psychotic:

ii. Immature:

iii. Neurotic:

iv. Mature:

12. Organise the following list into the appropriate type of defence mechanism:

projection, humour, fantasy, displacement, altruism, denial, acting out,

hypochondriasis, repression, isolation of affect, sublimation, reaction formation, suppression, anticipation, passive aggression.

Psychotic Immature Neurotic Mature

13. What can the use of humour achieve in an established therapeutic relationship?

_____________________________________________________________

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ANSWERS TO REVIEW QUESTIONS

CHAPTER 5 Awareness of and need for reflective practice

Answers to the following questions provide a summary of this chapter.

1. What is reflexive practice?

Reflexive practice focuses on the reasons why a practitioner or professional responds to particular events and how they affect these events. It focuses on the self – not the event.

2. Reflection is thoughtful exploration and consideration of the causes of events and reactions during events.

3. Reflection achieves ten possible outcomes – list at least eight of these.

i. Reflection increases awareness of unconscious or invisible emotional processes.

ii. Reflection can produce honest self-awareness; self-knowledge; self-acceptance;

self-control; self-respect and self-maintenance.

iii. Reflection is an important means of learning about attitudes, experiences and self.

iv. Reflection provides understanding of familiar and unfamiliar cultures.

v. Reflection facilitates resolution of the causes of negative responses during interactions.

vi. Reflection increases understanding of the influence of personality, other people and the environment upon communication.

vii. Reflection can improve skills in successfully managing negative emotional responses while communicating.

viii. Successful family/person-centred interventions.

4. What is the purpose of a model of reflection?

A model of reflection guides the process of reflecting – provides a way to reflect.

5. What do most models of reflection encourage?

A description of the event or interaction and comprehensive consideration of any factors that might explain the reactions during the event, exploration of the resultant feelings and how to resolve these and changes negative responses for future interactions.

6. What five actions are beneficial when reflecting regardless of the particular model of reflection?

i. Commit yourself to regular reflection.

ii. Allocate a regular time and place to reflect.

iii. Honestly identify unconscious emotional processes that negatively influence responses during interactions.

iv. Resolve emotional causes of these negative responses and/or suggest ways to avoid these responses during future interactions.

v. Make time to clarify the intention and feelings of all the communicating people.

7. What does reflection encourage when considering future events within interactions?

Reflection can encourage consideration of how to clarify the intention or purpose of each interacting person during future interactions.

FOR EXAMPLE: Choose a model of reflection that suits my personality and learning style. Buy or establish an electronic template for; a reflective diary. Allocate regular time to reflect upon particular interactions and how I might positively influence such future interactions. Allocate time each month to read the entries and reflect upon any positive

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