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Psychoanalysis began with a focus on how the “intrapsychic” defense mechanisms of the individual helped to reduce and control conflict. More specifically, defenses were seen as helpful in managing the intensity of needs, desires, and affects that inevitably lead to conflict as the individual encounters the needs and desires of others around him. While the earliest theory of defenses focused more on maintaining internal equilibrium, contemporary theories of defense are seen as part of a set of relational and cognitive patterns that develop in the context of close relationships with important others. In the more contemporary psychodynamic approach to defense, many defenses are seen as protecting the self-esteem of an individual rather than axiomatically protecting an individual from becoming conscious of thoughts or ideas that would cause anxiety were they to be remembered or recognized. The shift to more object relational and interpersonal approaches for the understanding of defense has had major implications for clinical treatment, which are examined in this article.