Brill Lecture: Addressing Defenses: A Core Mechanism of Change in Psychodynamic Treatments

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The 62nd A.A. Brill Lecture:

“Addressing Defenses: A Core Mechanism of Change in Psychodynamic Treatments”

Tuesday, March 12, 2024

8:00 – 9:30 PM (EST)

Presenter and Honoree: Leon Hoffman, M.D.

Introduction by Robert Smith, M.D.

There is an ongoing tension in the psychoanalytic and psychodynamic field between interpreting the meaning of a patient’s verbal productions or actions and addressing the defenses as they occur in sessions. In addition, some authors maintain that implicit interactions between analyst and patient may be more important than the verbal interventions by the analyst. This communication argues the centrality of observing and appropriately addressing how patients manage/defend against painful affects that may arise at any point in treatment. Berta Bornstein and Paul Gray have been instrumental in promoting this perspective. This technique is experience-near and minimizes psychoanalytic/psychodynamic interventions which require a high level of conjecture by the analyst/therapist and are far from the patient’s consciousness. Several vignettes are provided which suggest that interpreting defense against painful affect is a pan theoretical construct. A successful randomized control trial utilizing this technique with children (Regulation-Focused Psychotherapy, RFP-C) is described. There have been limited empirical studies of the impact of therapists addressing defense in sessions but the work of J. Christopher Perry and colleagues, particularly the development of the Psychodynamic Intervention Rating Scales (PIRS) offers an opportunity to further study the impact of defense interpretations and other interventions.

1.5 Contact Hours for the program in its entirety. 1.5 CME/CE credits offered. See details below.

Leon Hoffman, M.D. is Co-Director of the Pacella Research Center of the New York Psychoanalytic Society and Institute. He is co-author with Timothy Rice and Tracy Prout of Regulation Focused Psychotherapy for Children (RFP-C): A Psychodynamic Approach and, with Timothy Rice, “Defense Mechanisms and Implicit Emotion Regulation: A Comparison of a Psychodynamic Construct with One from Contemporary Neuroscience. Among his discussions of social problems, he has published  “Psychoanalytic Perspectives on Populism” in Contemporary Psychoanalysis in 2018 and “The evolution of racism in the Western world: addressing fear of the other” in the Journal of the American Psychoanalytic Association in 2021.

Educational Objectives: Upon completion of this activity, participants should be able to:

1. Explain the importance of addressing defense mechanisms in analysis and psychotherapy.
2. Assess how the patient is defending against painful affect and intervene in an experience-near way.

Physicians
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of American Psychoanalytic Association and the New York Psychoanalytic Society & Institute. The American Psychoanalytic Association is accredited by the ACCME to provide continuing medical education for physicians.

The American Psychoanalytic Association designates this Live Activity for a maximum of [1.5] AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

IMPORTANT DISCLOSURE INFORMATION FOR ALL LEARNERS: None of the planners and presenters for this educational activity have relevant financial relationship(s)* to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. *Financial relationships are relevant if the educational content an individual can control is related to the business lines or products of the ineligible company.