Abstract
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.
Highlights
The concept of defense mechanisms has a long history in the field of psychology (Freud, 1894, 1936), in particular in the area of developmental psychology (e.g., Boldrini et al, 2020), psychopathology (Bond, 2004), and psychotherapy process and outcome research (e.g., Roy et al, 2009; Perry and Bond, 2012)
Our aim was to assess defense mechanisms used by therapists during the early days and months of the pandemic, and to establish the concurrent relationship between use of defense mechanisms and experiences of professional self-doubt and vicarious trauma, as well as the relationship between defense mechanisms and change in these professional stressors over time
We reported on two recruitment efforts of two similar online surveys completed by therapists in the early days of the pandemic (Study 1) and 3 months into the pandemic (Study 2), using two different self-report measures of Vicarious Trauma Predicted by overall defensive functioning (ODF) Vicarious Trauma at the initial timepoint ODF
Summary
The concept of defense mechanisms has a long history in the field of psychology (Freud, 1894, 1936), in particular in the area of developmental psychology (e.g., Boldrini et al, 2020), psychopathology (Bond, 2004), and psychotherapy process and outcome research (e.g., Roy et al, 2009; Perry and Bond, 2012). Defense mechanisms are categorized hierarchically based on their general level of adaptiveness (Perry, 1993; Perry and Bond, 2017) This hierarchy incorporates three overarching defense categories: (1) Mature defense mechanisms that include, for example, sublimation, altruism, anticipation, and humor; (2) Neurotic defense mechanisms that include intellectualization, undoing, isolation of affect, reaction formation, displacement, and repression; and (3) Immature defense mechanisms that include, for example, acting-out, splitting, projection, projective identification, idealization, devaluation, denial, passiveaggression, and help-rejecting complaining (Perry and Bond, 2017). Though all defense mechanisms are thought to protect the individual from anxiety, mature defense mechanisms do not threaten interpersonal relationships or distort reality as neurotic or immature defense mechanisms do
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