Denial and Defense in the Therapeutic Situation: Theodore L. Dorpat, M.D.,  Jason Aronson, Inc., 1985,  293 pp.

This book attempts to integrate denial and defense into a comprehensive clinical theory for psychoanalysis. It develops its theory around the most primitive kinds of defenses and elaborates them in connection with psychoanalytic theory. Dorpat argues that denial, not primal repression or splitting, is the basic defense. This is the most significant, central contribution and rationale of the book. The basic method is clinical and the author develops a “cognitive arrest theory of denial,” the major hypothesis being that denial brings about an arrest of cognition regarding something disturbing to the subject. In that arrest, the individual interrupts normal thought processes, that is, of thought formation, and this prevents the construction of realistic verbal representations of the complex being denied. There then follows the individual's need to develop a cover story or screen concept to conceal the deficit of the cognitive arrest. It is felt that denial is the basic aspect of all defensive activity and is central to understand any clinical psychoanalytic process.

The author then hypothesizes that Freud erred in stating that repression was the primary defense. Freud and others had the mistaken notion that ideas and percepts are first admitted to consciousness and are then expelled, like from a container. Dorpat demonstrates, on the contrary, that at a presymbolic or free linguistic level, the denier aborts the cognitive process per se in transforming embryonic forms to verbal thought. In the microanalysis of defenses (p. 4), Dorpat clearly outlines his methodology. First, he notes that there is a preconscious appraisal of danger or trauma to the individual. Following that, there is a painful affect. That painful affect then induces the cognitive arrest or the denial process, and last, there is a screen behavior to substitute or cover over the arrest that has occurred.

While Freud postulated two basic defenses—repression and disavowal, Dorpat argues for just one defense