The view from the tip of the iceberg

In recent years there has been a growing interest in refining the technique of ego defense analysis. All of these approaches share in common an attempt to work closely with the patient's free associations, to interpret at a level that is accessible to the patient's consciously observing ego, and to avoid bypassing the analysis of the patient's most surface-level resistances in an effort to understand unconscious conflict. These innovations reflect a commendable effort to work in a way that is rigorously empirical, that respects the patient's autonomy, and that minimizes the pressure of the analyst's transferential authority in the patient's acceptance of the analyst's interpretations. Despite the undeniable value of these technical innovations, such approaches to ego defense analysis may inadvertently result in certain overemphases in technique that may unnecessarily constrain the analytic process. They may result in a sort of obsessive tunnel vision that is overly focused on small details to the exclusion of the larger picture. An approach that counterbalances the microscopic and the macroscopic analysis of ego defense is recommended.