What is Denial?

I loved what Oprah Winfrey used to say, “Honey, Denial is not a river in Egypt”.

Denial is the refusal to acknowledge the existence or severity of important conflicts, troublesome impulses, unpleasant events, actions, or illness.

The existence of unpleasant internal or external realities is kept out of conscious awareness, (denied). It is an unconscious defence mechanism. By keeping the stressors out of consciousness, they are prevented from causing anxiety.

While defence mechanisms protect our psychological wellbeing in traumatic situations, or in any situation that produces anxiety or conflict, they do not resolve the anxiety-producing situation over-all. Psychologists and psychotherapists think of defence mechanisms as being useful to solve a problem in the short term (i.e. avoid psychological pain or anxiety) but in the long term they don’t help (and, in fact, cause other problems as a result of using them).

In some cases, denial (again, only for a short time) can be useful. If, for example, someone knew of the sudden, unexpected death of somebody they love, at first they may not be able to accept the reality of this loss. The initial denial protects that person from the emotional shock and intense grief that goes along with news of death. Chronic or terminal illnesses also encourage denial. People diagnosed with these illnesses may think, “It’s not so bad; I’ll get over it,” or “Well, what do you expect at my age?” and refuse to make any lifestyle changes as a result of the denial. So, while it is protective in the short term, using denial long-term is actually harmful.

 

The 4 levels of denial

  1. Information Deficit
  2. Conscious Defensiveness
  3. Unconscious Defensiveness
  4. Delusion

 

Level 1 denial – Information Deficit.

  • Do not know that behaviours, thought patterns, or responses are wrong or are contributing to the problem.
  • Do not know there is a problem
  • Wrong information about the cause of the problem

Level 2 denial – Conscious Defensiveness.

  • Know that there is a problem but refuse to have the pain that comes from knowing. For example, “putting it out of my mind.”

Level 3 denial – Unconscious Defensiveness

  • Evasion and distortion of facts and truths that guard against severe pain. This happens ‘automatically’, i.e. without doing it on purpose.

Level 4 denial – Delusion

  • Mistaken beliefs held in spite of overwhelming evidence to the contrary. Usually deeply entrenched.

 

Treatment of Denial

Denial is treated differently in different types of therapy.

In some models of psychotherapy, denial is regarded as an obstacle to progress that must eventually be confronted and interpreted. Timing is important, and therapists will wait until clients appear emotionally ready or have some degree of insight into their problems before confronting them. Some therapists may not directly confront (the client’s use of) denial, but instead, facilitate clients to explore their world view, leading to considering alternative ways of being.

In cognitive behavioural therapy, denial is not important (i.e. the therapist does not work on interpreting the client’s unconscious). In CBT, it is more useful to think of denial as being that a person has not learned the appropriate behaviours to cope with a stressful situation. The Cognitive Behavioural Therapists help clients to examine their current thoughts, feelings, and behaviours and devise strategic ways to make changes that bring appropriate and useful results to help the client.