Discussing Defense Mechanisms and Coping Styles

Patients may benefit from discussing their maladaptive defenses and coping styles and exploring ways of effectively dealing with their situation. For example, an obsessive-compulsive patient has a high cholesterol level and is calling the physician's office for more details about other laboratory tests. The results of the lipid profile are given to the patient, who now wants to know whether a lifestyle change or a statin medication would work better. With the recommendation for an initial lifestyle plan of more exercise and nutritional counseling, the patient becomes concerned about how to pay for this. Repeated efforts to help the patient with additional information are not making the patient feel any better. In fact, more information just raises more requests for additional information. The patient is asked to come for another visit. At this visit, the physician might say, "I can continue to give you more information, but it seems that anxiety is driving your questions. What are you worried about?" In essence, this says, "Your coping style of seeking information and details is not helping you. If you can recognize your anxiety about this subject, you may feel calmer." Review Table 46-1 for specific defenses and coping styles. Interpreting defenses or modifying a coping style requires the ability to recognize these and then to implement the preparatory confrontations and clarifications before making an interpretation and subsequently suggesting new ways to cope with the situation.

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