PAPER PRESENTED AT THE 5th EUROPEAN CONGRESS OF BODY-PSYCHOTHERAPY April 27-30, 1995, Carry-Le Rouet, France

OPENING
I now routinely state the following "disclaimer" before I teach a course or give a lecture: What I am about to offer is theory and speculation - which is what most of psychology, and for that matter science, is. This means that no matter how pedantic and self assured I sound, I know that my statements are no more than my considered opinion. What I am hoping to achieve here is not so much to convince you of my point of view, as to stimulate thought, ideas and discussion.

INTRODUCTION
When I received the schedule of presentations for this conference, I was somewhat dismayed to realize that I had not offered a workshop on Post-traumatic Stress Disorder - my area of specialization. It's not that I had forgotten that the issue of supporting defenses was important - but I suspected that you knew that. So, why propose a presentation that you would just agree with? Then I remembered the time frame in which I prepared my proposal. Several events were significant:

• I had recently attended a friend's therapy as a support. During the therapy, my friend cried with shame about a defense that I honestly admired. She was astonished that I could wish to be more like her in an area where she felt such shame. My regarding her defense as a resource had a strong impact on her. It was my turn to be astonished when the therapist - a very experienced and talented person - interrupted our contact saying, "Well, let's get back to work !" Somehow the therapist had not considered support of my friend's defense as significant "work".
• At an international body-psychotherapy conference I had heard a trainer remark with irritation, "how can I work with clients who won't let me touch them?!".
• I had recently consulted in several cases where clients were being encouraged - sometimes required - to give up defenses: one, convinced by her therapist that the less boundary she had, the more she could access her process, was becoming increasingly decompensated; another, who had been required by his therapist to stop arguing, felt he had lost a strength; and a TA therapist still convinced that "pig parents" (the introject of a punishing and/or destructive parent) should be destroyed.
• I was also struggling with the results of a recent confrontation with one of my own clients where I angrily confronted a defense and she quit the therapy. My supervisor strongly supported my confrontation. These experiences bothered me. I concluded that it must not be so easy to put the principle of supporting defenses into practice. I came to believe that the topic might be relevant after all. As I was preparing the presentation, I also had some new thoughts about the difference between character and trauma defenses, and decided to integrate that aspect, too.

ON DEFENSES
Let's review the basics: One definition of "defense" in my Webster's Dictionary is: a means or method of defending or protecting oneself, one's team, or another. This definition certainly applies to psychological defense, which is also a protection. Without psychological defense, we human beings would not survive with our sanity and/or our bodies intact. Because of their survival and protective functions, defenses are inherently positive. They are formed to preserve our sanity and life. The positive role of defenses is also discussed in the DSM IV in a section proposing a "Defensive Functioning Scale" (See: APA, 1994):

Defense mechanisms (or coping styles) are automatic psychological processes that protect the individual against anxiety and from the awareness of internal or external dangers or stressors....Defense mechanisms mediate the individual's reaction to emotional conflicts and to internal and external stressors.

I like the term "coping styles" to refer to defenses, it acknowledges their positive value. One of my first clients at my first job in 1976 was a young, very schizoid, woman. My supervisor asked me to evaluate the client in many areas, including the defense mechanisms she used. As I mulled over Anna Freud's book on defense mechanisms (See: Freud, 1948), I came to the conclusion that much of my client's problem was that she lacked defenses. She couldn't repress, she couldn't sublimate, etc. She was overwhelmed by her feelings and experiences. She had no protection from them. One of the first things I did with her was to teach her how to not answer a question. She had no defense from the inquiry of others. She felt she had to answer all questions, and answer them truthfully. I taught her other options: "I don't know"; "I don't want to talk about that now"; "Let's talk about ______ instead"; or to give short, partial answers. I also taught her to ask questions, herself, to get the focus away from her: "And how are you ?", etc. That young woman desperately needed defenses. As a Radix Teacher in the early 1980's I had experienced personally, and with some of my clients, that the traditional Reichian methods of breaking down defenses could, in some cases, lead to breakdown and even psychosis (See: Rothschild, 1991). I discovered that I as well as some of my clients, needed to build up defenses - in both body and mind. Defenses must, I came to believe, have a positive function. But why, I wondered, are they such a problem? Defenses are usually formed in childhood and/or under extremes of stress or threat where behavioral options and resources are limited. One resulting problem is that once we create a defense to survive a particular situation, we tend to generalize it to other related (even distantly related) situations. We often keep using the same defense, even when it is not needed or appropriate. A defense, used outside of the context of the specific situation for which it was designed, can be - and often is - limiting. Two hypothetical examples:

1) If my father became angry when I needed help as a kid, then I may have given up asking for help, for fear of getting an angry response. It may not even occur to me that I need help from time to time, or that not everyone would become angry with such a request. Holding back my need for help as a child protected me from my father's wrath. But holding it back as an adult may keep me isolated, frustrated, and/or just plain tired. 2) If while being beaten and then raped, I reflexively froze to stop the rapist from further beating, I may still "go dead" while having sex with my husband. What saved me in the one situation, may be limiting my pleasure and contact now.

Another problem I see with defenses, is that they tend to be one-sided. Almost any defensive behavior is, in some situations, a resource - but not when we're stuck with it as the only option. I'll quote from my presentation description:

1) Defensive withdrawal is a resource - who doesn't need to withdraw at times? But withdrawal can be a problem when it is an automatic defensive reaction and is not balanced by, the ability to reach out after contact. The opposite is also true: a defense of constantly needing contact, is missing it's balance: the ability to withdraw and be alone. 2) Tense, defended shoulders, may help conquer stressful situations. But problems develop when one can't also choose to relax. Again, the opposite: chronically slack shoulders may enable one to quickly give up in a losing situation, but may be a problem when it could be useful to tolerate stress.

COUNTERTRANSFERENCE AND DEFENSE
I suspect that you will agree with me that helping a client to appreciate his defenses is a desired goal. You will also likely agree that this is often easier said than done, the biggest obstacle, I believe, being our own countertransference. I mentioned earlier that a client of mine had recently quit therapy after I had angrily confronted her defense. She had been complaining for 2 years that she lacked friends, but continued to resist all my brilliant support and interventions - psychological, body and behavioral - to help her build a network. One day I lost my patience with her. I confronted rather than supported her defensive resistance, with an attitude of "either do something about it or quit complaining". She was crushed, disappointed and angry with me. She felt betrayed. She quit therapy a couple of weeks later, saying she was ready to be on her own, including developing a network. Was that a positive step for her, or did my confrontation push her into compensation? My supervisor believed I had done the right thing. She thinks I waited too long to confront her. I am not so sure. I was not in a particularly good mood the day of the confrontation. Could my mood - my countertransference - have influenced my judgment? Is my supervisor's support from her sound judgment, or her own countertransference? I don't know.

CHARACTER AND TRAUMA
Understanding usually increases my ability to tolerate frustration - also with defenses. I have found it useful to distinguish two classes of defense. Each is expressed differently in the body and each protects survival in different ways:

Character Defenses protect the survival of the psychological self (core self, sanity, spirit, center) and include the standard defense mechanisms that we are most familiar with. Trauma Defenses protect the survival of the physical self and include the reflexes of fight, flight, and freeze and, the phenomenon of dissociation.

Character defenses appear to be mediated by the Central Nervous System (CNS). The CNS is responsible for muscle contraction, and thereby, for body movement. The CNS is involved in all forms of learned behavior, including the formation of character defenses. The balance between the Sympathetic (SNS) and Parasympathetic (PSNS) branches of the Autonomic Nervous System (ANS) may also play a role in character defense formation, depending on the degree of stress or frustration involved. Character defenses are formed during development in response to differing interactions and frustrations within our growing-up environment. The developmental theory postulated by the Bodynamic Institute lends an excellent understanding to the interaction of motor development and psychological development. Their theory describes how psychological defenses can be expressed in the body as either overly tensed or overly slack muscles (See: Bentzen, Jørgensen and Marcher, 1989). Something that I would like to add to their - as well as other - theories of personality formation is how the motor and psychological responses that become defenses are conditioned. Character Defenses are developed through repetitive interactions that modify behavior. They serve to protect the psychological self from pain, anxiety, and/or frustration: i.e., if we repeatedly can't get what we need, we stop needing; if the expression of an emotion repeatedly results in rejection, we stop that expression; etc. I've gone back to my first college psychology course and the work of the experimental psychologist, B.F. Skinner, to better understand the foundation of character defense formation. It occurs to me that character defenses are formed through a kind of operant conditioning - do you remember the "Skinner Box?" Skinner's most basic experiment with operant conditioning involved a bird in a box that would get food pellets when it tapped a lever. When the lever tapping was consistently reinforced (the bird received one food pellet for each tap of the lever), the bird continued to tap the lever. When the bird didn't get food (non-reinforced), it quickly gave up tapping on the lever. When it got intermittent reinforcement (one food pellet for a random number of lever taps), it continued tapping the lever - sometimes frantically -, whether or not it got food (See: Skinner 1961). Basically, the bird connects the cause and effect of its lever pressing and being fed. It continues it's behavior accordingly, either: when I press this lever, I get food; when I press it I don't; or I don't know when I'll next get food, so I have to keep pressing it. People seem to respond in much the same way to varying kinds of contact. When an infant receives contact every time it reaches out, it continues to reach out when it needs contact. If the infant doesn't receive contact - for whatever reason - it gives up reaching out. If the infant gets intermittent response, it will continue to have the impulse to reach out, and may continue frantic reaching out, or block the impulse in frustration. You can apply this principle to the development of most if not all character defenses. Think about the child who is stopped from expressing anger. How is the defense that develops different depending on if he was stopped consistently or intermittently? What about the workaholic? Were his achievements overly reinforced? Or was he never stopped from frantic activity with appropriate boundaries? Two case examples:

• A middle-aged man was raised by parents who were not able to give very much emotionally. He was a bright child, and did well in school. His parents were able to acknowledge his high achievement. They were very proud of him. The man became "hooked" on performance and achievement to maintain the recognition and attention of his parents. As an adult he was a workaholic and perfectionist. He was conditioned to perform. He came into therapy because of problems with stress.
• A middle aged woman was raised always to be sweet and polite. Anger was not allowed in her home. She never heard her parents fight. As an adult she was afraid of conflicts. When she was angry with a friend, she would just end the relationship. She had been conditioned to never be angry. She came to therapy feeling isolated and lonely.

Trauma defenses, on the other hand, are clearly mediated by the Autonomic Nervous System (ANS). The role of the ANS in stress and trauma, as well as in the development of Post-Traumatic Stress (PTS) and Post-Traumatic Stress Disorder (PTSD) is well documented in the literature on the physiology of stress (See, among others: Bloch, 1985), body-psychotherapy (See, among others: Levine, 1992; Rothschild, 1993), and traditional psychology (See, among others: Scrigner, 1988; van der Kolk, 1993; Everly, 1993). Trauma defenses are formed under extreme conditions where there is actual or perceived threat to life. They have the function of preserving the physical self - the body. Some trauma defenses are purely reflexive, regulated by the limbic system of the brain which is responsible for the "'four f's' of survival: feeding, fighting, fleeing and sexual reproduction (See: Ornstein, 1984)." Other trauma defenses may be formed by decisions made during traumatic events. And some trauma defenses are a combination of decision and reflex. What trauma defenses all have in common, though, is very high SNS activation that both preceded the defense formation, and continues to hold the defense in place. Reflexive trauma defenses include: fight, flight and freezing, and, I believe, dissociation. Dissociation may be a kind of inward flight that is used, "...for psychological survival during overwhelming events when flight is impossible" (See: Lowewenstein, 1993). Reflexive defenses are, as the name implies, reflexes. They are not something that one chooses with cognition. They are not conditioned. They are an instinctive response to extremes of threat and are used to preserve life. Some examples:

• Running from a smoky movie theater. (flight)
• Fighting off an attacker. (fight)
• Going dead during rape. (freeze)
• Out of body experiences during surgery. (dissociation)

Traumatic defenses formed through decision have a "trauma logic" of their own. They always make sense for the situation in which they were created, but they can have dire consequences (See: Rothschild, 1994). Sometimes a trauma decision can be made to save life, at the risk of sanity, as in the following case example:

A girl was raped at 5 by a stranger. The rapist threatened her with death if she ever told. She believed him. She stood outside her home struggling to decide if she dared risk telling her mother, but was too frightened - frozen - to tell. She never told anyone. Consequently, she cut off contact with her mother - who had been a source of comfort and security - in order, she believed, to save her life. In her late teens, and into adulthood, she became more and more isolated emotionally, depressed and had periods of psychosis. She attempted suicide several times. The five year old believed she was saving her life, she couldn't have foreseen the consequences her decision to not tell - with it's resulting long-term isolation - would have on her life.

Reflex and decision can combine. Sometimes a decision during one traumatic event, can lead to modification of a trauma reflex during a later traumatic event. The following is a case example of how a reflexive flight response was modified by a decision during a traumatic event, and became a reflexive freeze response:

A young girl was threatened by a vicious dog. When she attempted to run (flight reflex), she was attacked and mauled. She made a decision that if ever again threatened, she would not run. Some years later, while being followed by a big man down a dark street, she didn't run. The man attacked her. She suffered a lot of guilt as a result. She had suspected the man might attack her. She could have out run him. Why didn't she run? In therapy she put the two events together and the significance of her decision, became apparent. The developed defense was completely logical and sensible in the situation involving the angry dogs. The problem with it was that it was too general: don't run.

Of course, character defenses and trauma defenses can have an influence on each other. The resources and limitations one brings to a traumatic event will influence the reflexes that are available and decisions that are made. The earlier and more massive the trauma, the more likelihood that the defensive system will be solely based on trauma defenses. Trauma, itself can become a kind of conditioning when repeated. This is true especially in cases of physical and sexual abuse, captivity, and torture (See: Herman, 1992).

SOME PSYCHOLOGICAL STRATEGIES FOR WORKING WITH DEFENSES
The common denominator of these differing types of defense is that they are used for survival. They are all initiated for a positive purpose. They can't be destroyed or gotten rid of without damage to the integrity of the self. A defense will tend to keep it's hold until it is understood and appreciated. Most clients will feel relief just to realize their defense really was for a good reason. Accepting and appreciating a defense is, of course, the first step in dealing with it. Editing a defense can also be an important strategy. In the example of the "don't run" decision mentioned above, what is needed is to specify when to run, and when not to run. De-generalizing a defense can also be a good editing strategy: who does this defense really apply to? Do you need it with everyone? In all situations? etc. Developing additional options can be important - as I described in my presentation description. For example: Yes, continue to withdraw when you want to; you need to be able to do that. And, are there any circumstances in which you would like to have, or try to have contact? Often a character defense needs to be updated. For example, the person who stopped asking for help because of dad's anger needs to update his situation. Is there anyone in his life now that he might be able to ask? A trauma defense will always need to be updated. This will help the client towards the realization that the traumatic event is no longer taking place, and that he has, in fact, survived. When working with trauma, support of the defenses is particularly central. Before a client can work with trauma issues, he needs to feel safe, and that won't be possible if defenses - either psychological or body - are being challenged, confronted or broken down.

SOME BODY STRATEGIES FOR WORKING WITH DEFENSES
The first step in working with body defenses is the same as for the psychological ones - acceptance. In addition to accepting how the, defensive tension or slackness is or has been protective or supportive psychologically, one needs to feel how it is protective physically. Uncovering the message in the bodily defense using body awareness can be of value. A case example:

I was consultant on a case where the client was ill and throwing up after each therapy session. Of course this was interfering with his courage to continue his therapy. I worked with the client and therapist exploring, with body awareness, what the nausea might be about. This led to work with boundaries and the physical space between client and therapist. The client felt more ill when the therapist was close by, and less when the therapist withdrew at least 2 meters. The nausea was further lessened when the therapist turned and looked away. The message became clear to us all - the therapist had been too close. In subsequent therapy sessions, the client paid much more attention to his need for physical distance from the therapist, and ceased to be ill after his sessions.

Body awareness can also be used when the body defense is tension or slackness. Stretching a tense muscle, or tensing a slack one accompanied by body awareness will give a lot of information about the defense. Sometimes it will be pleasant to stretch a tense muscle, sometimes it won't. The same is true for tensing slack muscles. Using body awareness, you can usually avoid the problems caused by releasing a tense muscle too much, or prematurely. Body awareness will also help avoid tensing muscles that need to remain slack. Nausea and spacing-out are usual signs of overly tensing a slack muscle. If you get an undesirable response, you can always make the opposite movement - i.e., re-stretch the slack muscle, or re-tense the tense one - to erase the effect. Of course, body defenses aren't only expressed as tension or flaccidity. Over- and underweight, some illness, addictions, conversion symptoms, etc. can also be bodily expressed defenses.

EXERCISES FOR WORKING WITH DEFENSES
I. Muscle Defense
Choose a muscle defense that is troublesome to you. It can be either an area of tension or slackness. Make a few notes about how this defense has been or is useful to you - how it may protect you.

1. Using body awareness, take an inventory of your current bodily state. Use terms like the following to describe it to yourself (it can be a good idea to write down key words for what you notice). hot, cold tense, relaxed big, small restless, calm movement, still dizzy shivers, prickles pressure, pulling rotation, twist contraction breathing: location and depth pulse pain, burning vibration, shaking weak, strong sleepy, awake yawning light, heavy soft, hard position in space tight, loose crooked, straight Don't describe your body awareness in terms of energy, energy flow or emotions. And don't use conclusions, such as "nervous" - there are always bodily clues that lead to such conclusions, e.g., shaking hands, raised heart beat and cold sweat under the arms.
2. Next, if you choose a tense muscle, stretch it; if you choose a slack muscle, tense it. You may have to try some different movements to isolate the muscle and get the right direction on your stretch or tense. Do the movement slowly and continuously. STOP before you reach the point of pain or exhaustion.
3. What body awareness do you notice in the muscle you are working with?
4. Release the stretch or tense very slowly.
5. What awareness do you notice now in that muscle?
6. What awareness do you notice in the same muscle on the other side of your body?
7. What do you notice in your whole body? Is it the same or different than when you started?
8. What conclusions do you draw about that muscle defense and the action you tried with it? Do you want to stretch or tense it more?
9. If you are feeling nauseous, dizzy or anxious, make the opposite action with the muscle you were working with, e.g., tense the muscle you stretched, or stretch the muscle you tensed.
10. Then check your body awareness again.
11. What conclusions do you draw from your reaction? Consider that if you had an unpleasant reaction, you may need to keep that tension or slackness - at least for a while longer.

II. Psychological Defense
Either writing alone or in conversation with a friend, colleague or therapist, discuss how you have survived in your life.

• What are the tools, resources, attitudes and defenses (body and psychological) that has made it possible for you to be where you are today?
• Choose one of your currently troublesome defenses.
• Where and how have you used that defense to survive?

III. Countertransference and Client Defenses
1) Choose one of the following to discuss with a colleague:

• A general pattern of client defense that is particularly difficult for you to support.
• A particular client defense that has been difficult for you to deal with.

2) Discuss the countertransference aspects that may be relevant to you.
3) Is there an issue for you to work on that would make it easier for you to accept this defense in your clients?

REFERENCES

American Psychiatric Association (APA), DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS, Forth Edition, 1994.

Bentzen, Marianne; Jørgensen, Steen; and Marcher, Lisbeth, "The Bodynamic Character Structure Model", Energy and Character, Vol. 20, No. 1, 1989.

Bloch, George, Ph.D., BODY AND SELF: Elements of Human Biology, Behavior, and Health. William Kaufmann, Inc., California, USA 1985.

Freud, Anna, THE EGO AND THE MECHANISMS OF DEFENSE, New York, 1948.

Herman, Judith L., MD, TRAUMA AND RECOVERY, Basic Books, 1992.

Levine, Peter D., Ph.D., THE BODY AS HEALER: TRANSFORMING TRAUMA AND ANXIETY, unpublished book manuscript, 1992.

Loewenstein, Richard, J., M.D., "Dissociation, Development and the Psychobiology of Trauma", Journal of the American Academy of Psychoanalysis, 21(4), 1993.

Ornstein, Robert & Thompson, Richard, THE AMAZING BRAIN, Houghton Mifflin, USA, 1986.

Rothschild, Babette, M.S.W., and Jarlnæs, Erik, "Nervous System Imbalances and Post-Traumatic Stress: A Psycho-Physical Approach", Manuscript, 1994.

Rothschild, Babette, M.S.W., "A Shock Primer for the Body-Psychotherapist", Energy and Character, Vol. 24, No. 1, April 1993.

Rothschild, Babette, M.S.W., " Bodynamic Body-Psychotherapy", Radix Review, Vol. I, No. 1, 1991.

Scrignar, C. B., M.D., POST-TRAUMATIC STRESS DISORDER: Diagnosis, Treatment and Legal Issues. Bruno Press, Louisiana, USA, 1988.

Skinner, B.F., "Teaching Machines", Scientific American, 205(5):90, 1961.

WEBSTER'S NINTH NEW COLLEGIATE DICTIONARY, Mirriam-Webster, Inc., 1984.

van der Kolk, Bessel A, M.D., and Fisler, Rita E., Ed.M., "The Biologic Basis of Posttraumatic Stress", Primary Care, Vol. 20, No. 2, 1993.