Abstract
The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery–Asberg Depression Rating Scale (MADRS). A subsample of 41 patients (19 responders and 22 non-responders) from an RCT was included. For each case, two sessions (the second and the penultimate) of brief inpatient psychodynamic psychotherapy (a manualized 12-session therapy program developed in Lausanne) were transcribed and then coded using the Defense Mechanism Rating Scales (DMRS) and the Psychotic Defense Mechanism Rating Scales (P-DMRS), an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient’s defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy.
Highlights
IntroductionPsychological defenses might be viewed either as a patient trait that determines the course and outcome of treatment, as a therapeutic outcome that evolves toward more adaptability, or as an underlying mechanism of change that explains how psychotherapy works from the psychodynamic theoretical perspective
From an empirical perspective, psychological defenses might be viewed either as a patient trait that determines the course and outcome of treatment, as a therapeutic outcome that evolves toward more adaptability, or as an underlying mechanism of change that explains how psychotherapy works from the psychodynamic theoretical perspective.Studies have suggested that defenses can be associated with depression
We address whether (a) defensive functioning and defense mechanisms help improve adaptiveness or maturity with therapy, (b) defenses and change in defenses are associated with treatment response and remission, and (c) defenses and change in defenses are associated with maintenance of treatment response after 12 months of follow-up
Summary
Psychological defenses might be viewed either as a patient trait that determines the course and outcome of treatment, as a therapeutic outcome that evolves toward more adaptability, or as an underlying mechanism of change that explains how psychotherapy works from the psychodynamic theoretical perspective. Studies have suggested that defenses can be associated with depression. Compared to a healthy control group, depressed individuals were found to use significantly more maladaptive and fewer adaptive defense mechanisms at baseline (Vaillant, 1986). DeFife and Hilsenroth (2005) showed that the presence and severity of depression symptoms were significantly related to lower (more maladaptive) overall defensive functioning (ODF) scores. Patients who lack obsessional defenses of mental inhibition (including isolation, undoing, and intellectualization) are more severely depressed.
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