Defense mechanisms 1
When a 2-year-old is hospitalized for tonsillitis, he will drink only from a bottle, even though his mother states he has been drinking from a cup for 6 months.
REGRESSION
"yes, I understand what you said."
*with eye contact and nodding*
Accepting
Verbalizing the implied
Putting into words what the patient has only implied or said indirectly is a technique that can be helpful with patients experiencing impaired verbal communication.
Stage 1
Denial
Compensation
A physically disabled boy is unable to participate in football, so he compensates by becoming a great scholar.
A woman’s husband is being transferred with his job to a city far away from her parents. She hides anxiety by explaining to her parents the advantages associated with the move.
INTELLECTUALIZATION
“You appear sad today.”
“I notice you are pacing a lot.”
“I notice that when I ask you about whether you have thoughts of suicide you change the subject.”
Making observations
Formulating a plan of action
Encouraging the patient to identify a plan for behavior change promotes developing better coping skills.
stage 2
Anger
rationalization
A patient tells the rehab nurse, “I drink because it’s the only way I can deal with my bad marriage and my worse job.”
A mother whose son was killed by a drunk driver channels her anger and energy into being the president of the local chapter of Mothers Against Drunk Driving.
SUBLIMATION
Patient: “I can’t study. My mind keeps wandering.”
Nurse: “You have trouble concentrating.”
Patient: “I can’t take that new job. What if I can’t do it?”
Nurse: “You’re afraid you will fail in this new position.”
Restating
Attempting to translate words into feelings
When the patient has difficulty identifying feelings or feelings are expressed indirectly, the nurse tries to “desymbolize” what has been said and to find clues to the underlying true feelings.
stage 3
Bargaining
DENIAL
A woman drinks alcohol every day and cannot stop, failing to acknowledge that she has a problem.
Children integrate their parents’ value system into the process of conscience formation. A child says to a friend, “Don’t cheat. It’s wrong.”
INTROJECTION
“Please explain that situation in more detail.”
“Tell me more about that particular situation.”
“You mentioned feeling like no one cares about you. Tell me more about those feelings.”
Exploring
Voicing doubt
Expressing uncertainty as to the reality of the patient’s perceptions is a technique often used with patients experiencing delusional thinking.
stage 4
depression
REACTION FORMATION
A student hates nursing and only attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career.
A young woman describes being attacked and raped without showing any emotion.
ISOLATION
“It’s difficult to believe that the President of the United States would be listening to all of your phone calls.”
“I find that hard to believe [or accept].”
“That seems rather doubtful to me.”
Voicing doubt
Using silence
Silence encourages the patient to organize thoughts and put them into words and allows the patient time to think about the significance of events, thoughts, and feelings. Allowing the patient to break the silence often provides the nurse with important information about the patient’s foremost concerns.
stage 5
acceptance
Displacement
A patient is angry with his physician, does not express it, but becomes verbally abusive with the nurse.