Introduction to “Defense Mechanisms in Psychotherapy”

Abstract

This issue of Journal of Clinical Psychology: In Session is devoted to the clinical appreciation of defense mechanisms. This construct is one of the early cornerstones of psychoanalysis and psychodynamic psychology, first described and conceptualized by Sigmund Freud in 1894. Since then we have had 120 years of developments in theory, methods of clinical identification, research, and clinical practice. The present issue is an attempt to examine how, at the present time, attending to defense mechanisms can extend our understanding of how people handle stress and conflict in a wide variety of contexts, including normal everyday life, as well as in psychotherapy and other clinical work. Defenses are fundamental mechanisms of personality that the clinician tries to affect in therapy, yet they also serve as markers of how a person is adapting and, as such, can even be viewed as outcomes. Therefore, we learn from them at every scale, from the individual instance of a slip of the tongue, to a summary of the defenses used in a session, to patterns of change in defenses over treatment and follow-up. The seven articles herein are linked by their focus on defenses as observed or identified by the clinician. The first article by Perry demonstrates a method that identifies individual defenses and shows what can be learned from them even in short vignettes. The article by Busch examines the defenses that characterize individuals with somatization symptoms and suggests how the clinician may respond. Berney and colleagues in Lausanne extend our understanding and identification of the defenses operating at the psychotic level, which have been neglected in recent years. Ulberg and colleagues in Oslo describe the interplay among defense, transference, and the interpretation of both when the therapist is either engaged or disengaged with the patient. DiGiuseppe and colleagues in Italy and elsewhere present a new software method that clinicians can use without extensive training to identify an individual patient’s defenses, track changes in defenses, and provide a clinical narrative of prominent manifestations of defenses. Beresford examines how attending to psychological adaptive mechanisms in several medical disorders and medical decision-making situations can aid the clinician. Finally, and fittingly, after examining defenses in many pathological contexts, Metzger describes the high adaptive defenses, focusing on the transformation of the stress response to a high level of adaptiveness. Taken together, these articles include something for everyone, clinician and layperson, user and observer of defenses, while demonstrating the robustness of the study of defenses. Defenses warrant our attention.