Addressing and interpreting defense mechanisms in psychotherapy: General considerations

Institute of Community and Family Psychiatry, Sir Mortimer B. Davis–Jewish General Hospital and McGill University, Montreal, QC.
Psychiatry Interpersonal & Biological Processes (Impact Factor: 3.05). 06/2011; 74(2):142-65. DOI: 10.1521/psyc.2011.74.2.142
Source: PubMed


Defense interpretations are commonly used techniques that clinicians employ more frequently than transference interpretations. How and when clinicians interpret defenses, however, has received little empirical examination. In an effort to facilitate the empirical study of defense interpretation, we reviewed 15 works by noted authors who gave a prominent role to interpreting defenses in discussing clinical work in general patient populations. Our goal was to identify and systematize distinct themes from these authors that might be testable hypotheses. We identified 74 themes related to the interpretation of defenses in psychotherapy-for example, "interpreting too frequently diminishes the emotional impact of interpretation"-which we organized into 17 distinct categories (e.g., factors associated with positive outcome). We subsequently selected 19 themes that were readily operationalizable as hypotheses and examination of which would advance clinical practice. These hypotheses address issues such as when, in what order, and how to interpret defensive material and what successful outcomes would be. We then describe prototypes of research designs, employing naturalistic observation, randomized controlled trials, or experimental laboratory studies, which could investigate these important hypotheses. Overall, this report codifies current clinical maxims and then provides future research directions for determining how clinicians can most effectively address defenses in psychotherapy.

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    • "Defense mechanisms are one of the earliest constructs in psychoanalysis derived from observation , beginning with Freud's 1894 publication, The Neuro-Psychoses of Defence (1894). More than a century later, defenses have proven to be one of the most durable constructs in psychoanalysis and dynamic psychiatry and psychology, spanning theory (Olson, Perry, Janzen, Petragia, & Presniak, 2011), therapy (Perry, Petraglia, Olson, Presniak, & Metzger, 2013), and research (Perry & Bond, 2012; Vaillant, 1993). The language of defenses and their functions thrive in everyday usage, as witnessed by phrases like the following: You're acting defensive. "
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    ABSTRACT: Standard teaching about defense mechanisms generally focuses on definitions, which do not readily aid the clinician in identifying defenses whenever individuals use them. This report demonstrates a process by which the clinician can identify when a defense is used, which ones are likely being used, and with what aim. Clinicians first notice that a defense may be operating whenever the other individual presents with anomalies in the expression of affect, behavior, speech, or its content. Some of these anomalies are described. Next, to identify the specific defense or general level of defensive functioning used, the clinician must identify the specific function of the defense in context using a process of guided clinical inference. This report examines 2 verbatim examples from recorded interviews of one case to demonstrate this process. The examples present a microcosm of clinical concerns that have a surprising relationship to the individual's course and prognosis.
    Journal of Clinical Psychology 05/2014; 70(5). DOI:10.1002/jclp.22085 · 2.12 Impact Factor
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    • "Similarly, Fenichel (1941) proposed that defenses should be interpreted before drives and conflicts could be analyzed. Indeed, starting with the interpretation of material more easily observable to the patient is a robust theme in the psychoanalytic theory of treatment (Olson et al., 2011). "
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    ABSTRACT: Interpreting or addressing defenses is an important aspect of psychoanalytic technique. Previous research has shown that therapist addressing defenses (TADs) can produce a positive effect on alliance. The potential value of TADs during the process of alliance rupture and resolution has not yet been documented. We selected patients (n = 17) undertaking a short-term dynamic psychotherapy in which the therapeutic alliance, measured with the Helping Alliance Questionnaire and monitored after each session, showed a pattern of rupture and resolution. Two control sessions (5 and 15) were also selected. Presence of TADs was examined in each therapist interpretation. Compared with control sessions, rupture sessions were characterized by fewer TADs and especially fewer TADs addressing specifically intermediate-essentially neurotic-defenses. Resolution sessions were characterized by more TADs addressing specifically intermediate defenses. This confirms the link between therapist technique and alliance process in psychodynamic psychotherapy.
    The Journal of nervous and mental disease 04/2014; 202(5). DOI:10.1097/NMD.0000000000000112 · 1.69 Impact Factor
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    • "For example , a dismantling study could test whether personalized meanings are an essential component of treatment by examining the impact of this intervention if the clinician failed to inquire regarding patients' idiosyncratic meanings. As a first step to empirically test defensive operations, Olson et al. (2011) "
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    ABSTRACT: We describe an integrative psychotherapy for first responders to the September 11, 2001 terrorist attack, including those who continue to be psychologically impacted by these events, most of whom meet criteria for a diagnosis of posttraumatic stress disorder. Three core techniques used in this treatment are described: (a) an emphasis on meaning making, particularly regarding the traumatic event; (b) focus on the most affect-laden components of the traumatic exposure; and (c) identifying and challenging the implicit strategies used by individuals to avoid discussion of components of their traumatic memories and the attendant negative affect. For each intervention, a theoretical rationale and the presumed mechanism of operation are presented. We discuss the clinical and research implications of this intervention. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychotherapy Theory Research Practice Training 09/2013; 50(3):336-40. DOI:10.1037/a0032526 · 3.01 Impact Factor
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