2.2.2 Defence Mechanisms and Other Barriers to Communication

Since communication is so critically important for delivering effective patient care, it is important to be aware of common barriers to communication.

Let’s begin with a look at defence mechanisms, which are psychological strategies that are unconsciously used to protect a person from anxiety and other negative emotional reactions.

There are many defence mechanisms, so you will not learn about all possible options today, but will explore some of the most common ones. Review the following list carefully. In addition to the examples provided, can you think of an example for each defence mechanism from your own personal experience?

Defence Mechanism Description Example
Repression Keeping unpleasant or disturbing ideas in the unconscious part of the brain. Your client is disturbed by a sexual dream about his mother.
Denial Blocking a situation or realization from one’s awareness when it is too much to handle. Your client smokes, but she says he’ll never get lung cancer because she eats healthy.
Projection Attributing one’s own feelings to another person or source rather than admitting these thoughts are one’s own. Your client uses homophobic terms and accuses people around him of being gay, but he himself has homosexual urges.
Reaction Formation Transferring one’s feelings into opposing behaviours. Your client is extremely warm and friendly to your colleague, whom she dislikes.
Displacement Satisfying an impulse by a substitute action. Your client is angry at her mother and she snaps at you.
Regression Returning psychologically to a time before a stressor arose. When her parents tell her they are getting divorced, your client experiences bedwetting for a few nights.
Sublimation Satisfying an impulse by a substitute action that is socially accepted and, often, constructive. Your client is angry about a break-up, and spends hours playing the piano.
Rationalization Constructing an explanation of why things aren’t so bad. Your elderly client says he didn’t mention to the doctor that his foot is bothering him because others his age are much worse off than he is.
Compartmentalization Separating your life into independent sectors helps one protect or avoid sensitive or stressful areas. Your client refuses to talk about why she’s crying because “it’s a personal matter.”
Intellectualization Removing the emotions from a tough situation and focusing on the data in order to move forward. Your client’s wife tells you that since his cancer diagnosis last week, he has spent every day locked in his office researching his disease.
Compensation Overachieving in one area of one’s life to make up for failures in another area. Your client dedicates most of his time to mastering chess after he begins needing a wheelchair.
Table: Defence mechanisms, definitions, and real-world examples.

This video will help to put the definitions of each defence mechanism together with actions—what these mechanisms look like in the real world:

Click here for a video transcript: Video Transcript.

Practice Makes Perfect

Match each statement with the defence mechanism that is in play:

Other barriers to effective communication include interrupting, giving unsolicited and unwanted advice, minimizing others’ problems, using patronizing language, failing to listen, or answering your own questions.


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