When outer functioning is mistaken for health
When I completed my undergraduate degree, I first heard a phrase that stayed with me:
If all you have is a hammer, everything starts to look like a nail.
I keep coming back to that idea when I think about psychology training.
What I am about to say is not an attack on CBT or other skills-based therapeutic approaches. These approaches absolutely have an important place in our field.
What I am questioning is whether our tertiary education culture – and I would say this especially in the Australian context – is currently nuanced and balanced enough to produce psychologists who can think deeply, flexibly, and integratively about complex human problems.
Because there is something I think we do not talk about enough:
Preserved outer functioning is not the same as psychological health.
Many people move through significant life events by relying on relatively immature or unhealthy defence mechanisms. These can include avoidance, compartmentalisation, denial, disavowal, and other ways of keeping difficult material out of awareness.
The problem is that these processes are often not obvious. Sometimes they are not even obvious to the person using them.
Externally, the person may look functional – in fact, that is often the point. These strategies are very good at preserving outer functioning. They help people keep working, keep performing, keep showing up, and keep meeting external demands.
But preserved outer functioning does not automatically mean that the person is coping in a healthy or integrated way.
A person can look “fine” while paying a very high internal price: less freedom, less spontaneity, less relational depth, less creativity, less generativity, and often a more distorted relationship with reality. Keeping a defensive system running takes energy, and that energy has to come from somewhere.
This is where I think our training culture can become too narrow.
In many tertiary settings, the emphasis is strongly on symptom reduction, behavioural strategies, practical coping, and measurable function. There is real value in that. But if this becomes the dominant language, we can start mistaking management for resolution, and functioning for health.
Take compartmentalisation as one example. In some situations, it can absolutely be adaptive. In acute stress, crisis, trauma, or survival contexts, it may be necessary and even lifesaving. But that is very different from treating compartmentalisation as a general sign of healthy coping simply because the person remains outwardly functional.
Some strategies are adaptive only when they are temporary, context-sensitive, and not replacing more mature processes such as grieving, reflecting, integrating, symbolising, and working through conflict.
This is the part I think we need to understand more clearly: psychological health, especially in the longer term, requires flexibility in coping. When a person becomes heavily reliant on the same entrenched strategy over and over again – especially one based on avoidance, compartmentalisation, denial, or emotional shutting-down – that may preserve functioning, but it can also point away from health rather than toward it.
In that sense, entrenched coping can become a contradiction of health rather than a sign of it.
Long-term psychological health requires more than the ability to push difficult material aside and keep going at all costs. It requires some capacity for integration: the ability to face difficult emotions, stay with them for long enough, reflect on them, and gradually metabolise them, rather than only managing them through distance, suppression, or over-control.
If functioning is preserved only by repeatedly refusing contact with inner or outer reality, then we need to ask whether we are looking at coping, or at a well-organised defence (system).
This is why I think depth psychology still matters.
Psychodynamic and psychoanalytic concepts are not outdated. They may be less fashionable in some training cultures, but they still provide essential language for understanding internal conflict, defence, symbolic meaning, and the gap between looking well and actually being well.
If we lose that language, we risk training clinicians to recognise only what fits the dominant model in front of them.
And that brings me back to the hammer.
If our students are mainly trained in one language of mind, one language of symptoms, one language of intervention, then there is a real risk that everything will start to look like a case for that model. Not because the clinicians are careless, but because their conceptual toolkit has become too narrow.
What I am advocating for is not less CBT.
It is more balance.
A strong tertiary education culture should be able to produce clinicians who can think across models, tolerate complexity, and recognise when preserved outer functioning may be masking a heavy internal cost.
To me, a balanced psychology needs both:
– practical skills and depth
– symptom relief and meaning
– behavioural strategies and understanding of defence
– outer functioning and inner reality
Because complex human problems require clinicians who can recognise, tolerate and hold complexity.
Aliz Ovlachi - Clinical Psychologist & Author 