Facilitating the Genetic Counseling Process Practice-Based Skills, Second Edition

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There are several different types of defense mechanisms, in addition to those
described earlier in this chapter, that we define and illustrate with examples in
Table 9.1.

9.2.2 Examples of Patient Defenses

In a study of challenging situations involving informed consent for genomic
sequencing (Tomlinson et  al. 2016 ), one genetic counselor participant expressed
concern that a “...genetically savvy participant who had an advanced degree in
molecular genetics was focused on the details and limitations of sequencing rather
than the implications of results for herself and her family: ‘I think at least on the
pre-test side if I had to guess, based on how much she was focusing on that, it was
almost like a defense mechanism for her [intellectualization]. You could already see
her skepticism with any results that might come back and whether she would actu-
ally believe any of them because she was focused so much on the limitations of the

Table 9.1 Patient defense mechanisms

Definition Patient examples

Denial: Rejecting the possibility that an

event happened

“Nobody ever told me I was at risk:”

“He’ll grow out of it:”

“She looks just like my mother, and my mother is

ok.”

Displacement: Shifting response from

the original aim to a vulnerable target

“I won’t get any useful information from your

incompetent lab.”

Identification: Assuming the attitude or

behavior of an idealized person or group

“My sister says it’s foolish to worry about a few

ultrasound glitches.”

“My friend says that if I have an amnio I’ll have a

miscarriage.”

Intellectualization: Avoiding intolerable

feelings through abstract, precise

thinking with little or no feeling

“So, it is a statistical probability that with this type

of translocation a fetus would expire.”

Projection: Blaming other people or

situations for difficulties the patient

experiences

“I know you think I’m a fool to continue this

pregnancy.” (in reality, the patient feels foolish.)

Rationalization: Justifying objectionable

information with plausible statements

“Everyone has some abnormal genes... I’m probably

not any more at risk than anyone else.”

“But I take my prenatal vitamins every day!”

Regression: Reverting to

developmentally less mature behavior

A well-educated and articulate couple, upon hearing

abnormal test results, suddenly were unable to

process any further information. They kept saying,

“what do you mean?”

Repression: Putting intolerable thoughts

and feelings out of one’s mind

“I don’t remember how many miscarriages I had.”

Undoing: Canceling out a distressing

experience through a reverse action

An obsessive need for prenatal testing after having

a child with anencephaly

Adapted from Clark ( 1991 )

9 Patient Factors: Resistance, Coping, Affect, andfiStyles