Accuracy of Defense Interpretation in Three Character Types

Abstract

Defense mechanisms are one of the most durable constructs in psychoanalysis and dynamic psychiatry/psychology, spanning theoretical, clinical, and research approaches. While the construct originated with Freud’s 1894 [1] publication, The Neuro-Psychoses of Defence, the first seven decades of psychoanalytic writing largely advanced the theoretical understanding and clinical approaches to defense mechanisms, while the research did not begin in earnest until about the last 40 years, accelerating somewhat more recently. Much of this research has understandably concentrated first on issues of how to assess defenses [2, 3], second, on the relationship of defenses to clinical disorders, such as depression [4] and personality disorders [5, 6], and, third, on change in defenses over time and long-term development [7]. In recent years, this latter avenue has expanded to include treatment outcome studies indicating that defenses and defensive functioning improve with treatment [4, 8–10]. To date, these have been naturalistic observational studies of patients in treatment and follow-up, but they have also begun to examine the role of defenses in the processes of change with psychotherapy. Kramer et al. [11] found that change in distress was mediated by prior improvement during psychotherapy of defensive functioning, but not of conscious coping. Perry and Bond [12] reported that change in defense mechanisms at 2.5 years of long-term dynamic psychotherapy predicted change in multiple measures of symptoms and functioning at 5 years. While we await additional research to establish that change in defenses mediates improvement in symptoms and functioning, it is important to explore and delineate therapeutic processes that lead to change in defenses. This chapter, then, is an effort to examine some early hypotheses and approaches to determining how therapeutic interventions lead to change in defensive functioning within and across psychotherapy sessions.