Supportive Care in Cancer

, Volume 15, Issue 3, pp 333–337 | Cite as

Psychodynamic aspects of communication skills training: a pilot study

  • Nathalie Favre
  • Jean-Nicolas Despland
  • Yves de Roten
  • Martin Drapeau
  • Mathieu Bernard
  • Friedrich Stiefel
Original Article


Goals of work:

Communication between patients and oncology clinicians is a key element of cancer care. Emotionally charged consultations may trigger clinicians’ defense mechanisms, protecting them from painful emotions. Defense mechanisms, however, may also hamper the recognition of patients’ suffering. This pilot study aims to explore clinicians’ defense mechanisms observed in communication skills training (CST).

Patients and methods:

A verbatim transcription of videotaped interviews with simulated patients were evaluated before (N = 10) and after CST (N = 10) with the defense mechanism rating scales (DMRS).

Main results:

A wide variety of defense mechanisms were observed such as obsessional (e.g. intellectualisation) or disavowal (e.g. denial or projection). Immature defense mechanisms decreased after CST.


A wide variety of defense mechanisms are operant in oncology clinicians facing challenging interviews with simulated patients. Defense mechanisms may be modified by CST.


Communication skills training Defense mechanisms Cancer DMRS Simulated patients 


  1. 1.
    Ablon JS, Jones EE (1998) How expert clinicians’ prototypes of an ideal treatment correlate with outcome in psychodynamic and cognitive-behavioral therapy. Psychother Res 8:71–83CrossRefGoogle Scholar
  2. 2.
    Baile WF, Kudelka AP, Beale EA, Glober GA, Myers EG, Greisinger AJ, Bast RC, Goldstein, MG, Novack D, Lenzi R (1999) Communication skills training in oncology: description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer 86:887–897PubMedCrossRefGoogle Scholar
  3. 3.
    Baile WF, Beale EA (2001) Giving bad news to cancer patients: Matching process and content. J Clin Oncol 19:2575–2577PubMedGoogle Scholar
  4. 4.
    Despland JN, Drapeau M, de Roten Y (2001) Les mécanismes de défense: une pluralité de points de vue. Psychothérapies 3:113–121Google Scholar
  5. 5.
    Despland JN, Stiefel F, Favre N, Drapeau M, de Roten Y (2005) Adaptation of the defense mechanism rating scales for evaluating therapists’ defense mechanisms: principles, reliability and face validity. Society for Psychotherapy Research, European and UK Chapters, Lausanne, 3 Mar 2005Google Scholar
  6. 6.
    Drapeau M, De Roten Y, Perry JC, Despland JN (2003) A study of stability and change in defense mechanisms during a brief psychodynamic investigation. J Nerv Ment Dis 191:496–502PubMedCrossRefGoogle Scholar
  7. 7.
    Fallowfield L (1995) Can we improve the professional and personal fulfillment of doctors in cancer medicine? Br J Cancer 71:1132–1133PubMedGoogle Scholar
  8. 8.
    Fallowfield L, Lipkin M, Hall A (1998) Teaching senior oncologists communication skills: results from phase I of a comprehensive longitudinal program in the United Kingdom. J Clin Oncol 16:1961–1968PubMedGoogle Scholar
  9. 9.
    Fallowfield L, Jenkins V (1999) Effective communication skills are the key to good cancer care. Eur J Cancer 35:1592–1597PubMedCrossRefGoogle Scholar
  10. 10.
    Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R (2002) Efficacy of a cancer research UK communication skills training model for oncologists: a randomised controlled trial. The Lancet 359:650–656CrossRefGoogle Scholar
  11. 11.
    Fallowfield L, Jenkins V (2004) Communicating sad, bad and difficult news in medicine. The Lancet 363:312–319CrossRefGoogle Scholar
  12. 12.
    Florio GA, Donnelly JP, Zevon MA (1998) The structure of work-related stress and coping among oncology nurses in high-stress medical settings: a transactional analysis. J Occup Health Psychol 3:227–242PubMedCrossRefGoogle Scholar
  13. 13.
    Ford S, Fallowfield L, Lewis S (1996) Doctor–patient interactions in oncology. Soc Sci Med 42:1511–1519PubMedCrossRefGoogle Scholar
  14. 14.
    Guex P, Stiefel F, Rousselle I (2002) La communication: Un élément central en cancérologie. Revue Francophone de Psycho-Oncologie 1:43–46Google Scholar
  15. 15.
    Guldberg CA, Hoglend P, Perry JC (1993) Scientific methods for assessing psychological defences. Nordic Journal of Psychiatry 47:435–446 Taylor & Francis, United Kingdom (peer reviewed journal)Google Scholar
  16. 16.
    Kiss A (1999) Communication skills training in oncology: a position paper. Ann Oncol 10:899–901PubMedCrossRefGoogle Scholar
  17. 17.
    Lerman C, Daly M, Walsh WP, Resch N, Seay J, Barsevick A, Birenbaum L, Heggan T, Martin G (1993) Communication between patients with breast cancer and health care providers: determinants and implications. Cancer 72:2612–2620PubMedCrossRefGoogle Scholar
  18. 18.
    Levinson W, Roter D (1993) The effects of two continuing medical education programs on communication skills of practicing primary care physicians. J Gen Intern Med 8:318–324PubMedGoogle Scholar
  19. 19.
    Loge JH, Kaasa S, Hytten K (1997) Disclosing the cancer diagnosis: the patients’ experiences. Eur J Cancer 33:878–882PubMedCrossRefGoogle Scholar
  20. 20.
    Meier DE, Back AL, Morrison RS (2001) The inner life of physicians and care of the seriously ill. JAMA 286:3007–3014PubMedCrossRefGoogle Scholar
  21. 21.
    OPD Arbeitskreis (Hrsg) (1996) Operationalisierte Psychodynamische Diagnostik. Grundlagen und Manual. Verlag Hans Huber, BernGoogle Scholar
  22. 22.
    Parle M, Maguire P, Heaven C (1997) The development of a training model to improve health professionals’ skills, self-efficacy and outcome expectancies when communicating with cancer patients. Soc Sci Med 44:231–240PubMedCrossRefGoogle Scholar
  23. 23.
    Perry JC, Cooper S (1989) An empirical study of defense mechanisms. Arch Gen Psychiatry 46:444–452PubMedGoogle Scholar
  24. 24.
    Perry JC (1990) Defense mechanism rating scale, 5th edn. Cambridge University, BostonGoogle Scholar
  25. 25.
    Perry JC, Kardos ME, Pagano CJ (1993) The study of defenses in psychotherapy using the defense mechanism rating scales (DMRS). In: Ehlers W, Draguns JG (eds) The concept of defense mechanisms in contemporary psychology. Springer, Berlin Heidelberg New York, pp 122–132Google Scholar
  26. 26.
    Perry JC (2001) A pilot study of defenses in adults with personality disorders. J Nerv Ment Dis 1:651–660CrossRefGoogle Scholar
  27. 27.
    Perry JC, Guelfi JD, Despland JN, Hanin B (2004) L’étude empirique des mécanismes de défense est-elle possible? In: Perry J.C., Guelfi JD, Hanin B, Despland JN (eds) Echelle d’évaluation des mécanismes de défense. Traduction et adaptation française du defense mechanism rating scales. Masson, Paris, pp 1–32Google Scholar
  28. 28.
    Razavi D, Delvaux N, Marchal S, De Cock M, Farvacques C, Schlachmuylder JL (2000) Testing health care professionals’ communication skills: the usefulness of highly emotional standardized role-playing sessions with simulators. Psychooncology 9:293–302PubMedCrossRefGoogle Scholar
  29. 29.
    Skodol AE, Perry JC (1993) Should an axis for defense mechanisms be included in DSM-IV? Compr Psychiatry 34:108–119PubMedCrossRefGoogle Scholar
  30. 30.
    Stiefel F, Despland JN, Favre N, Guex P (2004) Effects of communication skills training on oncology clinicians’ communication styles and defense mechanisms. Oncosuisse (OCS-01595-08-2004)Google Scholar
  31. 31.
    Stiefel F, Favre N, Despland JN, de Roten Y (2006) Communication skills training in oncology: it works—a review of the literature. In: Stiefel F (ed) Communication in cancer care. Springer, Berlin Heidelberg New York (in press)Google Scholar
  32. 32.
    Vaillant GE, Bond M, Vaillant CO (1986) An empirically validated hierarchy of defense mechanisms. Arch Gen Psychiatry 43:786–794PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Nathalie Favre
    • 1
  • Jean-Nicolas Despland
    • 2
  • Yves de Roten
    • 2
  • Martin Drapeau
    • 3
  • Mathieu Bernard
    • 2
  • Friedrich Stiefel
    • 1
  1. 1.Psychiatry ServiceUniversity Hospital (CHUV)LausanneSwitzerland
  2. 2.Division of Psychotherapy ResearchDepartment of PsychiatryLausanneSwitzerland
  3. 3.The Institute of Community and Family PsychiatrySir Mortimer B. Davis Jewish General Hospital and McGill UniversityMontrealCanada

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