Accountability

The majority of people I see in therapy are there because they do not want to make a decision—they want me (their therapist) to make a decision for them. When I think of almost every mental or relational problem I have helped people with, there inevitably is a responsibility issue at the core of the matter. This is what the defense mechanisms of projections, displacement, splitting (triangulation), and others are defending against—personal accountability!

The following is a list of defense mechanisms(notice how many of them deal with responsibility avoidance at an unconscious, preconscious and conscious level):

Level 1 Defence Mechanisms
The mechanisms on this level, when predominating, almost always are severely pathological. These three defences, in conjunction, permit one to effectively rearrange external reality and eliminate the need to cope with reality. The pathological users of these mechanisms frequently appear crazy or insane to others. These are the "psychotic" defences, common in overt psychosis. However, they are found in dreams and throughout childhood as healthy mechanisms.
They include:
· Denial: Refusal to accept external reality because it is too threatening; arguing against an anxiety-provoking stimuli by stating it doesn't exist; resolution of emotional conflict and reduce anxiety by refusing to perceive or consciously acknowledge the more unpleasant aspects of external reality.
· Distortion: A gross reshaping of external reality to meet internal needs.
· Delusional Projection: Grossly frank delusions about external reality, usually of a persecutory nature.
Level 2 Defence Mechanisms
These mechanisms are often present in adults and more commonly present in adolescence. These mechanisms lessen distress and anxiety provoked by threatening people or by uncomfortable reality. People who excessively use such defences are seen as socially undesirable in that they are immature, difficult to deal with and seriously out of touch with reality. These are the so-called "immature" defences and overuse almost always lead to serious problems in a person's ability to cope effectively. These defences are often seen in severe depression and personality disorders. In adolescence, the occurrence of all of these defences is normal.
These include:
· Fantasy: Tendency to retreat into fantasy in order to resolve inner and outer conflicts.
· Projection: Projection is a primitive form of paranoia. Projection also reduces anxiety by allowing the expression of the undesirable impulses or desires without becoming consciously aware of them; attributing one's own unacknowledged unacceptable/unwanted thoughts and emotions to another; includes severe prejudice, severe jealousy, hypervigilance to external danger, and "injustice collecting.” It is shifting one's unacceptable thoughts, feelings and impulses within oneself onto someone else, such that those same thoughts, feelings, beliefs and motivations as perceived as being possessed by the other.
· Hypochondriasis (a.k.a. somatization): The transformation of negative feelings towards others into negative feelings toward self, pain, illness and anxiety.
· Passive aggression: Aggression towards others expressed indirectly or passively.
· Acting out: Direct expression of an unconscious wish or impulse without conscious awareness of the emotion that drives that expressive behavior.
Level 3 Defence Mechanisms
These mechanisms are considered neurotic, but fairly common in adults. Such defences have short-term advantages in coping, but can often cause long-term problems in relationships, work and in enjoying life when used as one's primary style of coping with the world.
These include:
· Displacement: Defence mechanism that shifts sexual or aggressive impulses to a more acceptable or less threatening target; redirecting emotion to a safer outlet; separation of emotion from its real object and redirection of the intense emotion toward someone or something that is less offensive or threatening in order to avoid dealing directly with what is frightening or threatening.
· Dissociation: Temporary drastic modification of one's personal identity or character to avoid emotional distress; separation or postponement of a feeling that normally would accompany a situation or thought.
· Intellectualization: A form of isolation; concentrating on the intellectual components of a situation so as to distance oneself from the associated anxiety-provoking emotions; separation of emotion from ideas; thinking about wishes in formal, affectively bland terms and not acting on them; avoiding unacceptable emotions by focusing on the intellectual aspects.
· Reaction Formation: Converting unconscious wishes or impulses that are perceived to be dangerous into their opposites; behavior that is completely the opposite of what one really wants or feels; taking the opposite belief because the true belief causes anxiety. This defence can work effectively for coping in the short term, but will eventually break down.
· Repression: Process of pulling thoughts into the unconscious and preventing painful or dangerous thoughts from entering consciousness; seemingly unexplainable naiveté, memory lapse or lack of awareness of one's own situation and condition; the emotion is conscious, but the idea behind it is absent.
Level 4 Defence Mechanisms
These are commonly found among emotionally healthy adults and are considered the most mature, even though many have their origins in the immature level. However, these have been adapted through the years so as to optimize success in life and relationships. The use of these defences enhances user pleasure and feelings of mastery. These defences help the users to integrate conflicting emotions and thoughts while still remaining effective. Persons who use these mechanisms are viewed as having virtues.
These include:
· Altruism: Constructive service to others that brings pleasure and personal satisfaction.
· Anticipation: Realistic planning for future discomfort.
· Humour: Overt expression of ideas and feelings (especially those that are unpleasant to focus on or too terrible to talk about) that gives pleasure to others. Humour enables someone to call a spade a spade, while "wit" is a form of displacement (see above under Category 3).
· Identification: The unconscious modelling of one's self upon another person's character and behavior.
· Introjection: Identifying with some idea or object so deeply that it becomes a part of that person.
· Sublimation: Transformation of negative emotions or instincts into positive actions, behavior, or emotion.
· Suppression: The conscious process of pushing thoughts into the preconscious; the conscious decision to delay paying attention to an emotion or need in order to cope with the present reality; able to later access uncomfortable or distressing emotions and accept them.

Defense mechanisms protect us from being consciously aware of a thought or feeling which we cannot tolerate. The defense only allows the unconscious thought or feeling to be expressed indirectly in a disguised form. When these defenses become dysfunctional, dangerous, deviant or distressing, a person needs to seek treatment; however, it is essential to know that many of these defenses operate within all of us. These defenses are not inherently negative, some may be quite positive, like sublimation. However and indeed, many of these defenses can contribute to responsibility avoidance. For example, I once worked with an individual who was in extreme denial surrounding his extreme heroin addiction. He had convinced himself that it was natural and even healthy for him. He felt that everyone was out to get him and as long as he could maintain his job and his relationships, there was no reason to change. In a therapy group for substance abuse, many of the group members tried to “break him.” They would challenge and confront him until they were blue in the face (literally). However, none of their efforts worked. Yet one day he presented the group with a very depressed affect which was unlike his usual bravado. He stated, “My girlfriend left me and I think I am going to get fired, all because of my drug use.” Now, the defenses were down and the group could get some real work done. He was now ready, willing and somewhat able to grow out of this dysfunction… so we thought. As the group gave him suggestions, and praised him on “seeing through the pink haze,” he began to become a little bit stoic. He then began to follow the group’s lead by asking for advice, which they in turn were eager to give. Over the next week, he practiced the behaviors that the group told him to do, began a 12-step program as they had advised, and he attempted to be as honest as he could with others, also as the group had advised. During the next group, he was absent, and he never returned. “What happened… he was doing so well?,” group members asked. On a private phone call I had with him some weeks later, he told me that the 12-step group was full of “self-righteous do-gooders,” the people he attempted to be honest with rejected him, and all the advice the group had given him had “blown up in his face.” He has made the group accountable for his failed attempts of sobriety.
How do we evoke accountability within ourselves when we may be in a state of defensiveness? It has much to do with our relationships with others and how they respond to us. Good feedback from those who care does not include advice, this will only perpetuate responsibility avoidance. Good listening is key to evoke accountability.
Thomas Gordon described some roadblocks to listening:
• Asking questions
• Agreeing, approving, or praising
• Advising, suggesting, providing solutions
• Arguing, persuading with logic, lecturing
• Analyzing or interpreting
• Assuring, sympathizing, or consoling
• Ordering, directing, or commanding
• Warning, cautioning, or threatening
• Moralizing, telling what they “should” do
• Disagreeing, judging, criticizing, or blaming
• Shaming, ridiculing, or labeling
• Withdrawing, distracting, humoring, or changing the subject
“Why are they roadblocks?” Gordon continues:
“They get in the speaker’s way. In order to keep moving, the speaker has to go around them… They have the effect of blocking, stopping, diverting, or changing direction… They insert the listener’s ‘stuff’… They communicate: One-up role: `Listen to me! I’m the expert.’ And they put-down (subtle, or not-so-subtle).”
Certainly, it is a difficult, if not an impossible job to evoke accountability in others, and very often it is difficult to evoke accountability in ourselves. The first step is to realize that there are many aspects of our lives that we do not want to investigate. The second step is to become aware of the fact that we are responsible for those aspects; we are even responsible for things outside of ourselves. In a strange way, it can be liberating to know that we are responsible for everything in our environment—we are not to blame—but we are responsible.