Studying Change in Defensive Functioning in Psychotherapy Using the Defense Mechanism Rating Scales: Four Hypotheses, Four Cases

Abstract

(from the chapter) In psychoanalytic psychology, defense mechanisms are widely viewed as one constituent in the structure underlying personality or character. For instance, in his description of the difference between psychotic, borderline, and neurotic levels of personality organization, Kernberg [10] noted particular defenses along with identity formation and reality testing as the cornerstones of character. Recognizing the advances in assessing defenses (see below), defenses were added in Appendix B of DSM-IV [II] as a dynamic aspect of personality that could be coded separately from PDs. The presumption is that individuals tend to use the same repertoire of defenses, and these constitute the defensive structure of personality. Structural change over the course of treatment should then result in improvement in defensive functioning, i.e., a change in the defense repertoire toward more adaptive defenses. Advances in assessing defenses now allow us to track changes in defenses so that psychotherapists can see the effects of treatment on their patients during and after treatment. This chapter is devoted to this issue. This chapter will examine one method of rating defense mechanisms, the Defense Mechanism Rating Scales (DMRS), and demonstrate how it may be used in the study of psychotherapy process and outcome. Using a longitudinal perspective on four cases, we will demonstrate how defenses can be viewed as a dynamic outcome variable, in addition to their usual function as mechanisms operating from moment to moment in real time. Although defensive and coping functioning are currently separated, if not divorced, we will also present some early data suggesting that a reconciliation may be possible based on the commonality of overall level of functioning, allowing defense and coping to relate to one another once again, if not actually remarry. (PsycINFO Database Record (c) 2014 APA, all rights reserved)