Studying Defense Mechanisms in Psychotherapy using the Defense Mechanism Rating Scales

The Development of the Attachment Defenses Questionnaire (ADQ-50): A Preliminary Examination of Reliability, Validity, and Factor Structure

This paper marks the initial phase in the development of the Attachment Defenses Questionnaire (ADQ-50), a self-report tool crafted to assess defense mechanisms associated with attachment processes, catering to both clinical and research contexts. Anchored in the theoretical framework of attachment theory, the ADQ posits that an individual's internalized attachment style plays a influential role in predicting their defense mechanisms. The paper outlines the comprehensive development and refinement process of the ADQ-50. In Study 1 a preliminary 176-item version of the ADQ was examined. Data was collected online drawing from participants sourced from Prolific and undergraduate students (N = 1994). Study 2 further refined the ADQ, evaluating its initial convergent validity with a diverse participant pool (N = 726), including undergraduates, Prolific contributors, general practice medical patients, and individuals from social media. Exploratory factor analysis revealed a robust ten-factor structure, resulting in a 50-item scale aligning with theoretical expectations and demonstrating good psychometric properties. Findings, limitations, strengths and future research directions are discussed. We posit that the ADQ holds great potential to deepen our comprehension of defense mechanisms linked to attachment, with wide-ranging implications for clinical practices.

Maladaptive defense mechanisms moderate treatment outcome in 6 months versus 12 months dialectical-behavior therapy for borderline personality disorder

OBJECTIVE

We investigated whether defense mechanisms in patients with borderline personality disorder (BPD) predict treatment response of dialectical behavior therapy (DBT) and whether they moderate outcome in different treatment lengths.

METHOD

We analyzed a subsample of 60 outpatients with BPD, randomized into either 6 (n = 30) or 12 (n = 30) months of DBT. The average level of defensive adaptiveness, assessed with observer-rated overall defensive functioning (ODF) and "immature" (i.e., maladaptive) defenses were used as predictors and moderators of self-reported frequency of self-harm. We conducted a Generalized Linear Mixed Model (GLMM).

RESULTS

A lower ODF at treatment onset predicted smaller reductions in self-harm, irrespective of treatment length (IRR = 0.92, 95% CI = [0.86, 0.99], p = .020). Lower order "immature" ("major image distorting") defenses showed significantly smaller (IRR = 1.13, 95% CI = [1.06, 1.21], p < .001) and higher order "immature" ("minor image distorting") defenses showed significantly larger (IRR = .91, 95% CI = [.85, .97], p = .006) reductions in self harm in the 6-month but not in the 12-month treatment.

CONCLUSION

Even though the results have to be regarded as preliminary due to the small sample size, findings might indicate that patients with BPD and lower average defensive adaptiveness may benefit from individualized treatment plans including specific interventions targeting defense function.

Immature defense mechanisms mediate the relationship between negative life events and depressive symptoms

Objective

This study aimed to analyze the patterns of life events (LEs) and defense mechanisms in outpatients with depression and investigate the mediating role of defense mechanisms in the association between LEs and depressive symptoms in a psychosomatic outpatient sample in China.

Materials and methods

All of 2,747 outpatients (aged 18-65) from psychosomatic department were investigated in this study. LEs, depressive symptoms, and defense mechanisms were assessed by the Life Events Scale (LES), Patient-Health-Questionnaire-9 (PHQ-9), and the Defense Style Questionnaire (DSQ), respectively.

Results

Based on the optimal cut-off point of PHQ-9, 1840 (67.0%) patients had a PHQ-9 score of 10 or higher (depression group), and 907 (33.0%) had a score below 10 (non-depression group). The scores of Negative Life Events (NLEs), immature and intermediate defense mechanisms in the depression group were significantly higher than those in the non-depression group, while the scores of mature defense mechanisms were the opposite (p < 0.001). NLEs was directly related to depressive symptoms (b = 0.010, p < 0.001), and significant indirect effect via immature defense mechanisms (b = 0.008, p < 0.001) was observed.

Conclusion

Immature defense mechanisms play an important mediating role in the relationship between NLEs and depressive symptoms. Helping patients improving defense mechanisms and dealing with NLEs may be of great help in the treatment of relevant patients.

Defense mechanisms are associated with mental health symptoms across six countries

Defense mechanisms are adaptative processes that are related to mental health and psychological functioning and may play an important role in adaptation to distress, as well as in mental health interventions. The present study aimed to compare the use of defense mechanisms and their relationship to mental health symptoms across six countries. In a large-scale descriptive study, we collected data from community- based individuals (N=19,860) in the United States, Australia, Canada, Germany, Italy, and the United Kingdom about the use of defense mechanisms and experienced mental health symptoms during the early phase of the pandemic. We found that the use of defense mechanism categories was similar across countries. Moreover, lower defensive functioning, specifically, neurotic and immature defenses were related to experiencing higher distress across countries, whereas mature defenses were generally inversely related to symptoms. Furthermore, these findings were relatively similar across the six countries. Cross-cultural research on defense mechanisms and mental health has important clinical implications. Our results are consistent with the goal of promoting more adaptive defensive functioning to increase psychological well-being and mitigate the detrimental impact of situational stress.

Problematic internet use in emerging adulthood to escape from maternal helicopter parenting: defensive functioning as a mediating mechanism

The increasing use of the Internet has raised concerns about its problematic use, particularly among emerging adults who grew up in a highly digitalized world. Helicopter parenting, characterized by excessive involvement, overcontrol, and developmentally inappropriate behavior, has been identified as a potential factor contributing to problematic Internet use (PIU). Under these circumstances, considering that emerging adults navigate their adult lives and strive to reduce their sense of being in-between, implicit emotion regulation strategies, such as defense mechanisms, may help comprehend PIU. The present questionnaire-based study investigated the associations between maternal and paternal helicopter parenting and PIU through defensive functioning among a community sample of 401 cisgender emerging adults (71.82% females; 82.04% heterosexuals; Mage=24.85, SD=2.52) living in Italy. About one-fourth (25.19%) reported PIU. Greater maternal, B=0.904, SE=0.235, p<.001, but not paternal, B=0.343, SE=0.188, p=.068, helicopter parenting was significantly associated with PIU through a less mature defensive functioning. Conversely, neither maternal, B=1.158, SE=0.722, p=.109, nor paternal, B=0.355, SE=0.731, p=.628, helicopter parenting had a direct association with PIU. The results suggest the importance for psychotherapists to incorporate individuals' defense mechanisms and parent-child relationship history when designing tailored interventions for effective treatment of PIU. This emphasis is crucial because, in the context of a developmentally appropriate parenting style, relying on more mature defenses after psychotherapeutic intervention can lead to healthier adjustment among emerging adults.

Psychometric Properties of the Defense Mechanisms Rating Scales-Self-Report-30 (DMRS-SR-30): Internal Consistency, Validity and Factor Structure

Assessment of defense mechanisms has a longstanding history within the clinical psychology and psychopathology literature. Despite their centrality to clinical practice, there are few self-report measures that assess defenses and, those that do exist, have limitations in addressing individual defenses and levels of defensive functioning. To address this need, we investigated the psychometric properties of the Defense Mechanisms Rating Scale - Self-Report - 30 item (DMRS-SR-30) with a global, community sample of 1,539 participants who responded to an online survey about distress and coping. Exploratory factor analysis found a three-factor model for the DMRS-SR-30 - mature, mental inhibition and avoidance, and immature-depressive. Internal consistency was high for the Overall Defensive Functioning (ODF) and the three extracted factors with coefficient alphas ranging from .75 to .90. Examination of concurrent validity with a commonly used measure of defensive functioning found significant relationships in the predicted directions. The group of immature defenses had the strongest concurrent validity (r = .50). Finally, correlations with external criteria - including psychological distress and adverse childhood experiences - supported the convergent and discriminant validity of the DMRS-SR-30. The three factor structure of the DMRS-SR-30 has good psychometric properties. Limitations and directions for future research, as well as clinical implications, are described.

The Relationship Between Defense Mechanisms and Attachment as Measured by Observer-Rated Methods in a Sample of Depressed Patients: A Pilot Study

Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients’ defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients’ attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients’ attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy.

Defense Mechanism Functioning in Patients With Breast Cancer: Using the Defense Mechanism Rating Scale

Background: Breast cancer (BC) is one of the highest incidence rates in Lebanon. Previous studies had focused scarcely on the unconscious protective shield of patients with BC or BC survivors against cancer, while only some studies had focused on the relationship between defense mechanisms (DMs) and high adaptation with the disease process and progress. Therefore, this study aimed to investigate the reaction of inpatients with BC toward the disease by measuring DMs in the Lebanon context.

Methods: Seventy inpatients with BC were recruited randomly from six hospitals. Their DMs were measured using the Defense Mechanism Rating Scale. Moreover, the Relationship Anecdotes Paradigm (RAP) was used with three recent life vignettes of initial diagnosis, family, and daily life. The data were analyzed using repeated measure ANOVA, Wilcoxon rank-sum test, and Spearman's rank.

Results: Patients with stage 2 BC used more high-adaptive defense levels than patients with stage 4 BC who used more minor image distorting defense levels. Moreover, patients with stage 2 BC used more self-observation and undoing, while patients with stage 4 BC used more devaluation.

Conclusion: The severity of BC, the age of carriers, and the social status may lead to higher use of DMs, at the level of the individual defense and the hierarchal or the tripartite levels.

What Do Therapist Defense Mechanisms Have to Do With Their Experience of Professional Self-Doubt and Vicarious Trauma During the COVID-19 Pandemic?

This is the first study to examine psychotherapists' levels of defense mechanisms, their concurrent relationship with professional work-related stress (professional self-doubt and vicarious trauma), and how their levels of defense mechanisms predict the changes in these professional stresses over the course of 3 months since the start of the COVID-19 pandemic. Data from two online studies (Study 1; N = 105 and Study 2; N = 336), using two self-report measures of therapists' defense mechanisms (Defense Style Questionnaire-40 in Study 1 and Defense Mechanism Rating Scales Self-Report-30 in Study 2), are presented. Therapists reported higher levels of mature defense mechanisms, and lower levels of immature defense mechanisms, compared to published community and clinical populations assessed before and during the pandemic. Therapists' lower level of mature defense mechanisms and higher levels of neurotic and immature defense mechanisms were related to higher concurrent levels of vicarious trauma and professional doubt. Therapists who reported higher levels of mature defense mechanisms at 3-month follow-up showed less vicarious trauma and professional self-doubt at follow-up, after controlling for these professional stressors at baseline. Implications for clinical supervision and training are discussed. The context and professional challenges during the pandemic are unique and future replications of the results outside the pandemic context are warranted.

The Role of Suppression and the Maintenance of Euthymia in Clinical Settings

Background: Defense mechanisms serve as mediators referred to the subjects' attempt to manage stressors capable of threatening their integrity. Mature defense mechanisms represent the high adaptive group, including suppression, which allows the subject to distance disturbing contents from consciousness. In line with general defensive intents, suppression would preserve stable mood states, as in the case of euthymia. Clinical issues usually disturb homeorhesis, so that the study of subjects' suppressive tendencies would suggest possible existing relations among defense mechanisms, mood states, and clinical issues. The study highlighted the significant existing relations among factors such as suppression, euthymia, mood states, and clinical psychological phenomena. Methods: The observation group was composed of 150 participants, 51 males (34%) and 99 females (66%), aged from 25 to 30 years old, with a mean age of 26.63 years old (SD = 1.51). The study was conducted through the use of measures related to subjects' characteristics, euthymia, psychological flexibility and psychological well-being (Euthymia Scale), suppression (Suppression Mental Questionnaire), well-being (Who-5), and compassion (ProQol-5). Results: The performed analyses consisted of descriptive statistics, correlations, differences, and regressions among the considered variables. Starting from the first hypothesis, SMQ factors appeared to be significantly and positively correlated with Euthymia factors, rather than Regression in the Ego service (-). In line with the previous result, significant and positive correlations emerged among SMQ and Well-being (WHO-5) variables, maintaining an inverse relation with Regression in the Ego service. Significant differences emerged between male and female groups concerning SMQ total score and rationalization, with higher male group scores. Finally, significant dependencies emerged among the selected predictors (SMQ variables) and Compassion satisfaction. Conclusion: The emerged results highlighted significant relations among the considered variables so that it was possible to highlight the common directions assumed by suppression variables, well-being, and euthymia. Moreover, suppression appeared as a significant predictor with a causal role in clinical satisfaction. The results that have emerged allow us to consider defenses through an empirical perspective, useful to suggest an extension to other groups, phenomena, and conditions.

Defense Mechanisms and Repressive Coping Among Male Breast Cancer Patients

Objectives: The concept of defense mechanisms has undergone extensive revision and expansion since Freud first described these processes. Initially formulated as an unconscious repression of unpleasant memories, with further development focusing on the role of defense mechanisms in the regulation of internal conflicts, the concept shifted and evolved to incorporate the adaptation to external demands, including intrapsychic and interpersonal handling of burden of illness. In addition to defense mechanisms, coping provides another perspective on human adjustment to difficult life events. While there is substantial research on both coping and defense mechanisms in various psychiatric and somatic diseases, including cancer, little is known about defensive regulation, coping, and their interaction in male breast cancer patients. Methods: The present study is part of the N-Male project conducted between 2016 and 2018 in Germany (Male breast cancer: patients' needs in prevention, diagnosis, treatment, rehabilitation, and follow-up care). Semi-standardized interviews with 27 male breast cancer patients were analyzed with regard to defense mechanisms. In addition, fear of progression and repressive coping was assessed by self-report. Results: There was considerable variety in levels of defensive functioning as well as repressive coping in our sample. We found no difference in overall levels of defensive functioning between men with vs. without repressive coping. However, patients with repressive coping demonstrated a decopupled association between fear of progression and defensive functioning as compared to patients without repressive coping. Discussion: The study provides the first evidence of disease processing in male breast cancer patients Knowledge of patients' defense patterns and repressive coping seems promising for better planning targeted intervention strategies.

Preliminary Reliability and Validity of the DMRS-SR-30, a Novel Self-Report Measure Based on the Defense Mechanisms Rating Scales

Defense mechanisms are psychological factors that influence emotional distress and quality of life. There are a number of measures assessing the construct of defense mechanisms, but only few available instruments reflect the gold-standard theoretical hierarchical organization of defenses. We report on the development of a novel 30 item self-report questionnaire, the DMRS-SR-30, based on the parent instrument, the Defense Mechanism Rating Scales (DMRS). This study tested preliminary reliability and validity of the Italian version of the DMRS-SR-30. We first extracted 30 items from the DMRS Q-sort version (DMRS-Q) and adapted them for a self-reported format. We then applied the DMRS quantitative scoring algorithms to provide proportional scores for the 28 individual defenses and summary scores for seven defense levels and overall defensive functioning (ODF) scores. A dynamic interview was used for assessing participant's defense mechanisms with the observer-rated DMRS and DMRS-Q. We examined internal consistency of the scales along with criterion, concurrent, convergent and discriminant validity among participants (N = 94) who completed the DMRS-SR-30, SCL-90, BDI, and IES-R. Results showed very good internal consistency for ODF (Cronbach's alpha = .890) and the high adaptive defense level, whereas some subscales with few items had lower values. Correlation analyses between DMRS-SR-30 and the two DMRS-based observer-rated measures showed very good criterion and concurrent validity for ODF and moderate to high for defense levels subscales. Correlations between the DMRS-SR-30 ODF and SCL-90 GSI, BDI and IES=R (r = -.456, r= -.540, r = -.402, respectively, all p <.001), indicated good convergent validity. Despite the well-known limitations of self-report methods of psychodynamic phenomena, self-report measures are highly practicable for assessing large samples. The DMRS-SR-30 is the first self-assessed measure describing the whole hierarchy of 28 defense mechanisms and providing scores for ODF, defensive categories, defense levels, and individual defenses. Preliminary examination of the Italian version of the DMRS-SR-30 showed promising results of internal consistency, criterion and concurrent validity, and convergent validity and of the measure. Further validation is needed to confirm these findings and explore other aspects of validity and reliability.

Emotional Suppression and Oneiric Expression in Psychosomatic Disorders: Early Manifestations in Emerging Adulthood and Young Patients

Background

The function of emotions, beginning from the proto-emotions, is the adaptation to the environment. This is based on the Homeorhesis, the equilibrium due to the adaptive operation of excitement and the dissipation of emotions. The object relations of the participants foresee the practice of defense mechanisms in a continuum that goes from the consciousness to the oneiric activities. The predominant and maladaptive use of defense mechanisms in the psychosomatic phenomenology, can be identified with deficits in emotional awareness, with the impossibility to manage excitement and dissipation of emotions foreseen by the oneiric phenomena.

Methods

The observation group is composed by 140 participants, 56 males (43%) and 84 females (57%),with pathological-functional disorders of psychosomatic domain. The study had been conducted with the use of measures related to the conscious defense of suppression (Suppression Mental Questionnaire), to the emotional awareness linked to the psychosomatic phenomena (Diagnostic Criteria for Psychosomatic Research Structured Interview-DCPR-SI) and to the states of perturbation and conservation of oneiric activities (The Manheim Dream Questionnaire-MADRE).

Results

Significant inverse correlations emerged among rationalization, repressive function and illness Denial, as for the suppression mental questionnaire factors and irritable mood, but for Regression in the service of the Ego; inverse and significant correlations emerged among suppression, repressive function, rationalization and gastrointestinal psychosomatic outcomes and among suppression, repression and cardiological psychosomatic outcomes. Regarding alexithymia, a positive correlation emerged with rationalization and inverse with Regression in the service of the Ego. Positive correlations emerged between illness denial and overall emotional tone, for disease phobia and meaningfulness and for cardiological psychosomatic outcomes and nightmare distress and recurring nightmares.

Conclusion

The study of such outcomes due to a prevalent defensive style based on suppression, suggest the identification of a key phenomenon, which translates into maladjustment that goes from functional disorders to parasomnia. The bridge established by the obfuscation of conscious contents until the manifestations of disturbance of ancient activities such as oneiric ones, expresses the need to transform an emotional maladaptive style, in line with classic literature and the current state of art.

Comparison and change of defense mechanisms over the course of psychotherapy in patients with depression or anxiety disorder: Evidence from a randomized controlled trial

BACKGROUND

Defense mechanisms play an important role in the development and maintenance of both health and psychopathology. Research is still in the early stages of investigating the specific relationships among diagnostic groups and defense mechanisms along with their response to different treatment types.

METHODS

For the present study a total of 47 outpatients diagnosed with depression or anxiety disorders were randomized to receive 25±3 sessions of cognitive-behavioral therapy with integrated elements of either emotion-focused therapy (CBT + EFT) or treatment components based on self-regulation theory (CBT + SR). An observer-rated method, the Defense Mechanism Rating Scale (DMRS) was used to code transcripts of the 1st, 8th, 16th and 24th session to assess change in defensive functioning.

RESULTS

Over the course of therapy, overall defensive functioning (ODF) as well as adaptive defenses increased significantly, whereas maladaptive and neurotic defenses did not change. At the beginning of treatment, the proportion of adaptive defenses and ODF was significantly higher in patients diagnosed with anxiety disorders than in patients with depressive disorders. However, depressed patients exhibited greater improvement in their defensive functioning over the course of therapy.

CONCLUSIONS

Results support the view of defense mechanisms as a useful transdiagnostic and transtheoretical concept and supports the notion that change of defense mechanisms may be a relevant mechanism of change in psychotherapy.

The Role of Defense Mechanisms in Emerging Personality Disorders in Clinical Adolescents

Background: Defensive functioning is related to overall mental functioning and personality traits in adults but only few studies investigated the role of defenses in adolescence. The present study analyzed the use of defense mechanisms in clinical adolescents to test how defensive functioning is related to age, gender, and personality traits.Design: 102 self-referred outpatients were interviewed using the Clinical Diagnostic Interview (CDI). Defense mechanisms and personality profile were assessed using the Defense Mechanisms Rating Scale (DMRS) and the Shedler-Westen Assessment Procedure-200 for Adolescence (SWAP-200-A) respectively.Findings: Multivariate analysis of variance showed significant age and gender differences in clinical adolescents; while younger teenagers used more immature defenses, older adolescents scored significantly higher in high-neurotic and mature defenses. Girls showed higher use of minor image distortion and neurotic defenses, whereas boys recurred more frequently to obsessional level defenses. Neither age nor gender differences were found for narcissistic defense level. Significant correlations between personality disorders and specific defenses were found for all personalities with sufficient base rate, with the exception of paranoid, schizotypal, and schizoid personalities.Conclusions: In line with previous studies we confirmed the hypothesis of an ontogenetic line of development of defense mechanisms. In addition, the present study found that age and gender differences in adolescence are related to the use of specific defenses that contribute to the development of the personality and various psychological capacities. Several clinical implications are linked to the systematic investigation of defense mechanisms in youth, although further studies are required to confirm these findings.

Resolving defence mechanisms: A perspective based on dissipative structure theory

Theories and classifications of defence mechanisms are not unified. This study addresses the psychological system as a dissipative structure which exchanges information with the external and internal world. When using defence mechanisms, the cognitive-affective schema of an individual could remain stable and ordered by excluding psychological entropy, obtaining psychological negentropy or by dissipating the energy of self-presentation. From this perspective, defences can be classified into three basic types: isolation, compensation and self-dissipation. However, not every kind of defence mechanisms can actually help the individual. Non-adaptive defences are just functioning as an effective strategy in the short run but can be a harmful approach in the long run, while adaptive defences could instead help the individual as a long-term mechanism. Thus, we would like to suggest that it is more useful for the individual to use more adaptive defence mechanisms and seek out social or interpersonal support when undergoing psychic difficulties. As this model of defences is theoretical at present, we therefore aim to support and enrich this viewpoint with empirical evidence.

Reviving and Refining Psychodynamic Interpretation of the Wechsler Intelligence Tests: The Verbal Comprehension Subtests

The Wechsler intelligence tests (currently Wechsler, 2008 , 2014) have traditionally been part of the multimethod test battery favored by psychodynamically oriented assessors. In this tradition, assessors have used Wechsler data to make inferences about personality that transcend cognition. Recent trends in clinical psychology, however, have deemphasized this psychodynamic way of working. In this article, I make a conceptual and clinical case for reviving and refining a psychodynamic approach to inference making about personality using the Wechsler Verbal Comprehension subtests. Specifically, I (a) describe the psychological and environmental conditions sampled by the Wechsler tests, (b) discuss the Wechsler tests conceptually in terms of assessing vulnerability to breakdowns in adaptive defensive functioning,

Identifying indicators of defensive activity in narration about important interpersonal relations

<b>Background</b><br /> One of the main components of psychological conversation that influence communication is psychological defensiveness. 
In the paper I propose processual – situational understanding of defensiveness, and its measurement based on coding system. Preliminary results on link between personality traits and defensiveness in people’s narratives are presented as well.<br /> <br /> <b>Participants and procedure</b><br /> To test proposed coding system, study was conducted with participants presenting different levels of personality organization’s (borderline: n = 35, 20 women, M = 26.09, SD = 4.82, neurotic: n = 29, 24 women, M = 25.90, SD = 5.25, integrated: n = 31, 26 women, M = 21.94, SD = 1.69). Correlation method was applied (Borderline Personality Inventory, Neuroticism Scale, Emotion Control Inventory), as well as narrative’s interviews. Participants’ statements were coded by competent judges (defensiveness and coherence of narratives), and by automatic lexical analyses (descriptive indicators).<br /> <br /> <b>Results</b><br /> Results indicate that proposed defensiveness coding system is a set of heterogeneous indicators, and four groups of indicators could be extracted. Correlations between those indicators and expression control (positive relation), and coherence of narratives (negative relation). Moreover, differences between borderline participants and neurotic ones emerged.<br /> <br /> <b>Conclusions</b><br /> Proposed coding system seems to be a heterogeneous but useful tool for assessing defensiveness during psychological interviews. It could be applied as an element of a procedural control measures, directed to test the reliability of psychological conversation.

Defense mechanisms and implicit emotion regulation: a comparison of a psychodynamic construct with one from contemporary neuroscience

A growing interest in the neuroscience of emotion regulation, particularly the subfield of implicit emotion regulation, brings new opportunity for the psychodynamic treatment of neuropsychiatric disorders of childhood. At the same time, psychodynamic theorists have become more aware of the centrality of affects in mental life. This paper introduces a manualized psychodynamic approach called Regulation-Focused Dynamic Psychotherapy (RFP-C). Theoretically based on the domain construct of implicit emotion regulation (ER), this approach posits that contemporary affect-oriented conceptualizations of defense mechanisms are theoretically similar to the neuroscience construct of implicit emotion regulation. To illustrate this theoretical similarity, the literature connected with both concepts is reviewed. The implications of this idea, which could promote an interface between psychodynamics and contemporary academic psychiatry and psychology, are discussed.

Development of a Q-sort version of the Defense Mechanism Rating Scales (DMRS-Q) for clinical use

This report focuses on the need to provide clinicians with a reliable and valid measure for detecting patient defense mechanisms "inside psychotherapy." To avoid the limitations of existing methods, we designed a Q-sort based on the theoretical definitions and criteria of the Defense Mechanisms Rating Scales (DMRS-Q), but one that does not require transcripts of clinical interviews or sessions and may be applied without specific training on defenses. The DMRS-Q is sensitive to changes in psychotherapy and its scores correlate significantly with various aspects of mental functioning, making it potentially available for the psychotherapy process and outcome research as well. We report the results of using the DMRS-Q on a systematic single case study with the aim of detecting changes in defense mechanisms during a long-term psychodynamic psychotherapy. The DMRS-Q reveals change both in quantitative scores and in the literary Defensive Profile Narrative.

Adaptive defense mechanisms: function and transcendence

This article reviews the high-adaptive (mature) defense mechanisms, along with case material illustrating each. These defenses are described in terms of not only the specific means by which they serve to ward off anxiety and manage conflict, but also how they often transcend their role as defenses by contributing to the creation of new "products" of value, such as new meanings, perspectives, modes of relating, and works of art or science. This report also discusses the implications of the use of adaptive defenses, especially humor, in the context of psychotherapy.

Clinical approaches to somatization

Somatization is the experience and expression of psychological distress through bodily symptoms. Somatization can be conceptualized as an emotional state that has not been represented symbolically or as a defense against intolerable emotions and fantasies. Bodily concerns can also function as a means of seeking responsiveness from others. Alexithymia refers to a difficulty identifying and symbolizing emotional states that has been found to be associated with somatization. When functioning as a defense, a focus on the body can be used to avoid frightening or intolerable feelings and fantasies, or to ward off aggressive fantasies by viewing oneself as physically damaged. Systematic studies have demonstrated the presence of the defense of somatization in mood disorders, particularly anxiety and panic disorders. In treating anxiety disorders, the therapist helps the patient to determine the nature of emotions and fantasies that the patient is defending against, particularly fears and conflicts surrounding anger and separation.

Training Effects with the Observer- Rated Cognitive Errors and the Coping Action Patterns Scales

The use of observer-rated scales requires that raters be trained until they have become reliable in using the scales. However, few studies properly report how training in using a given rating scale is conducted or indeed how it should be conducted. This study examined progress in interrater reliability over 6 months of training with two observer-rated scales, the Cognitive Errors Rating Scale and the Coping Action Patterns Rating Scale. The evolution of the intraclass correlation coefficients was modeled using hierarchical linear modeling. Results showed an overall training effect as well as effects of the basic training phase and of the rater calibration phase, the latter being smaller than the former. The results are discussed in terms of implications for rater training in psychotherapy research.

Toward developing a scale to empirically measure psychotic defense mechanisms

In recent years, research on psychological processes has greatly advanced our understanding of various psychopathologies. Defense mechanisms, for example, have been described as observable phenomena, and studies have shown meaningful relationships among these processes and other measurable dimensions of health and illness. Despite some notable exceptions, one area that has been overlooked is the empirical study of defenses in psychotic disorders. This is in part due to the lack of valid instruments measuring psychotic-level defenses. Propadeutic to creating an empirical scale for measuring psychotic defenses, the psychoanalytic and empirical literature on psychotic defenses is reviewed, after which the concept of psychotic defenses as measured by the P-DMRS (Psychotic-Defense Mechanism Rating Scales)--which can be used independently or in combination with the current DMRS (Defense Mechanism Rating Scales)--is operationalized. Finally, current research directions applying the P-DMRS to the clinical setting are presented, as well as its implications for guiding current clinical practice.

Les expériences vécues par les enfants de Duplessis institutionnalisés : les conséquences après plus de 50 ans

Dans cet article, les auteurs présentent les résultats qualitatifs recueillis à partir de questionnaires et d’entrevues semi-structurées destinés à documenter les expériences tant actuelles que passées des enfants de Duplessis institutionnalisés (EDI). Des exemples typiques et deux cas représentatifs sont présentés. Les résultats indiquent que les abus et la négligence subis par les EDI pendant l’enfance ont compromis leur ajustement psychosocial à long terme. Ils révèlent aussi que les EDI qui ont rapporté au moins quatre forces pendant leur enfance étaient plus susceptibles d’être protégés à l’âge adulte contre les effets négatifs de leur placement.

Coping and defence mechanisms: what's the difference?--second act

PURPOSE

Research into adaptational processes has sometimes been confusing as regards differentiating coping and defence mechanisms. This theoretical discussion is based on Cramer's effort to disentangle the two concepts concerning the psychological processes involved, as well as acknowledge their mutual overlapping. Although such an effort is needed, at the same time several issues should be re-addressed and further implications on the differentiation of coping and defence processes discussed, such as consciousness and intentionality, functionality, adaptiveness, and the question of trait versus state.

METHODS

Based on Cramer's review, a search was conducted for current models on defence and coping that address the aforementioned implications. Only theoretical models that differentiate the defence and coping concepts, without necessarily presenting related empirical evidence, were taken into account.

RESULTS

Recent integrative models of defence and coping yield a more differentiated picture with regard to these issues: coping includes conscious and unconscious efforts, coping and defence serve very similar functions, adaptiveness can be defined in qualitative (defences) and quantitative (coping) terms and the question of stability of defences and coping needs to be more fully explored empirically. Furthermore, the nature of the underlying fear can be theoretically differentiated and related to the difference between coping and defence. Also, the implication of competence-related aspects of functioning (coping) and of internal determinants of functioning (defence) is discussed.

CONCLUSIONS

Implications for research perspectives implying defence and coping concepts based on observer-rating methodology are proposed.

Répercussions d’une enfance vécue en institution : le cas des Enfants de Duplessis

Les conséquences négatives d’un placement en institution sur les enfants ont été documentées, mais aucune étude n’a porté sur les orphelins et les enfants placés une fois devenus adultes. Au Québec, les Enfants de Duplessis offrent un témoignage poignant des répercussions à long terme d’une enfance vécue en institution. Les histoires recueillies auprès de 40 hommes et 41 femmes ayant grandi en institution à l’époque de Duplessis font état d’un nombre élevé d’abus et d’expériences adverses, incluant les agressions physiques, psychologiques et sexuelles. Le milieu était peu stimulant et offrait peu d’opportunités de développer des relations d’attachement positives et significatives. Lorsqu’ils sont appariés et comparés à des adultes provenant de l’enquête Santé-Québec, les Enfants de Duplessis devenus adultes rapportent plus de problèmes de santé liés au stress et une détresse psychologique plus importante. Nos résultats indiquent également que les personnes ayant disposé de peu de ressources et d’aptitudes personnelles dans l’enfance sont les plus affectées par les expériences adverses.

Defense styles of pedophilic offenders

This pilot study investigated the defense styles of pedophile sexual offenders. Interviews with 20 pedophiles and 20 controls were scored using the Defense Mechanisms Rating Scales. Results showed that pedophiles had a significantly lower overall defensive functioning score than the controls. Pedophiles used significantly fewer obsessional-level defenses but more major image-distorting and action-level defenses. Results also suggested differences in the prevalence of individual defenses where pedophiles used more dissociation, displacement, denial, autistic fantasy, splitting of object, projective identification, acting out, and passive aggressive behavior but less intellectualization and rationalization.