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Leo Rangell (1969a, 1969b) posited the unitary theory of anxiety and revisited the question of signal anxiety versus affect as a trigger for defense in a intrapsychic conflict sequence. He studied ubiquitous microscopic intrapsychic processes before, during, and after the defense was triggered, preceding any psychic outcome, and concluded that no matter what the nature of an unpleasurable affect participating in the conflict, the immediate signal for the use of defense is anxiety. Subsequently, Rangell described an unconscious cognitive-affective sequence of impulse-anxiety-defense-psychic outcome while maintaining that anxiety continues as a trigger and motive for defense behind all other states of unpleasure. In this context, the anxiety is about unpleasure overwhelming the ego. Rangell (1969a; 1969b) identified an unconscious decision-making function within the ego’s expanded unconscious executive functioning which ultimately shapes the specific psychic outcome. Through interaction with self and object representations, intrapsychic trial actions, representative of an intrasystemic choice conflict within the ego , occur. Objects are assessed for intended discharge. The self is assessed for a feeling of anxiety signaling danger, or safety and mastery, an unconscious equivalent of ‘how safe, or how risky for me would be to do…?’. Harold Blum (1980, 1985) addressed the issues of personality continuity and the creative and integrative aspects of defense analysis . He writes: “…The means of defense itself may undergo a change of function…What is defended against may be…the drives, superego, [or]…other areas of ego functions which…have to be reclaimed and reintegrated. Both, intersystemic and intrasystemic conflicts require [the] analysis of defense and defended content…[in order to restore] personality continuity….[The analysis is aimed at] restoration of old connections and establishment of new links between different facets of personality, between past and present, reality and fantasy…” (1985, p. 12). Addressing the controversy of conflict vs. deficit , Blum (1985) and Murray (1995) maintained that throughout development the ego uses defense mechanisms as powerful, protective and adaptive tools in response to external, internal, real or imagined dangers. The excessive use of defenses can harm non- defensive personality functions. Defenses then can interfere with personality development, lead to constriction and pathological alterations of the ego (Papiasvili, 1995). As Ego deficits/ego weaknesses/ego alterations may be formed during the pre-conflictual development, some (e.g., Gedo, 1979) advocated alteration of technique, going ‘beyond interpretation’. Others (e.g., Arlow, 1980, 1987) saw the ego deficits as not occurring outside of (inter- or intra-systemic) conflict; therefore, benefitting from an individual sensitively tailored interpretative approach. Within, what came to be called Contemporary Ego Psychology , Paul Gray (1994, 2005), Fred Busch , (1992, 1993, 1995), Cécilio Paniagua (2008) and Alan Sugarman (1994) further developed Anna Freud’s contribution to the function of ego defenses, in particular applying principles from Freud’s ‘signal anxiety’ to aid defense analysis within the analytic method of free association . They initially emphasized the patient’s conscious participation in the analysis and the analysis of the superego and idealization, to foster autonomy in the therapeutic action. Both Busch and Paniagua, in different ways, amplified and further developed Gray’s ‘microstructural’ approach to psychic surface. Paniagua (1991, 2008, 2014) demonstrated how increased attention to psychic surface most fully captures id-ego interactions . Busch (2006) noted the importance of bringing what is unconscious to the
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