People often have emotional reactions to their experiences, and this of course includes patients. When events arouse difficult feelings in a patient—such as guilt, fear, or shame, among others—he or she may react defensively. Defense mechanisms are a person’s conscious or unconscious effort to protect the ego and self-esteem. However, they can create a barrier to communication. Furthermore, defense mechanisms that last for excessive periods of time, or that do not resolve, can raise mental health concerns.
As a medical assistant, you must be able to recognize defense mechanisms. You must also learn to navigate them by incorporating therapeutic communication into your daily activities. Following are some common defense mechanisms that you may encounter in the health care setting.
Denial is a refusal to accept something that may be painful, and it often follows a traumatic event such as a death in the family or a diagnosis of cancer. A patient in denial will not be able to focus on the news you are conveying.
Regression is a means of retreating from unpleasant situations. The regressive patient may retreat to a happier, more secure time in their life. An example of this defense mechanism is a child who has been toilet trained but begins bed-wetting again when a new sibling is born.
Rationalization is labeling as acceptable a behavior that may not be healthy. In essence, the individual is making excuses—rationalization is the mind’s way of avoiding guilt or embarrassment. For example, a driver may rationalize that it is acceptable not to wear a seatbelt because he travels only a few miles to work.
Undoing is meant to make amends for unacceptable behavior. For instance, an abusive spouse might shower excessive gifts upon the victim in a bid to “undo” or negate the abuse.
Sublimation is a means of channeling something socially unacceptable into an acceptable form. It would not be acceptable to be aggressive toward a medical assistant, for example, but someone who has aggressive tendencies might exhibit those behaviors through a sport such as football.
Projection is blaming others or attributing one’s own thoughts to others in order to avoid accepting accountability. For instance, a parent who abuses her child may lash out at a medical assistant for being too rough during a pediatric exam preparation.
In compensation, a person substitutes a strength for a weakness to avoid embarrassment or acknowledgement of deficiencies. For example, an oversized child who is not very intelligent might use his size to compensate, by exhibiting some power over other children.