Open door review



Change in defense mechanisms and coping over the course of short-term dynamic psychotherapy for adjustment disorder

Drapeau, M., de Roten, Y., Perry, J.C. & Despland, J.-N. (2003): A study of stability and change in defense machanisms during a brief psychodynamic investigation. Journal of Nervous and Mental Disease, 191(8), 496-502.
Perry, J.C. (2001): A pilot study of defenses in psychotherapy of personality disorders entering psychotherapy. Journal of Nervous and Mental Disease, 189, 651-660.
Perry, J.C., Beck, S.M., Constantinides, P., & Foley, J.E. (2009): Studying a change in defensive functioning in psychotherapy, using the Defense Mechanism Rating Scales: Four hypotheses, four cases. In R.A. Levy & J.S. Ablon (Eds.), Handbook of Evidence-based Psychodynamic Psychotherapy (pp. 121-153). New York: Humana Press.


In this study, we explored the role of overall defensive functioning by comparing it on the process level with the neighbouring concept of overall coping functioning. A total of N= 32 patients, mainly presenting adjustment disorder, were included in the study. The patients underwent STDP up to 40 sessions; three sessions per psychotherapy were transcribed and analyzed by using two observer rating-scales: Defense Mechanism Rating Scales (Perry, 1990) and Coping Action Patterns (Perry, Drapeau, Dunkley and Blake, 2005). Hierarchical linear modeling was applied to model the change over the course of therapy and relate it to outcome. Results suggest that SDTP has an effect on the target variable of overall defensive functioning, which was absent for overall coping functioning. Links with outcome confirm the importance of the effect.


The aim of our study was to describe change in defense machanisms and coping explore links between their evolutions over the course of STDP, on the one hand, and the therapeutic outcome, on the other. Our first hypothesis postulated a greater increase in the target variable of defenses than in coping over the course of STDP. The results were in line with the assumption: Coping remained unchanged, whereas defenses traded up towards more mature functioning (see also Drapeau et al., 2003; Perry, 2001; Perry et al., 2008). Our methodology, being process-oriented, remains anchored in categorical systems operationalizing defenses and coping. Alternative conceptions of adaptational processes are proposed by Sampson and Weiss (1989), where the focus of attention is the individuals increasing capacity to regulate his or her defenses, without them being necessarily more mature, reflects therapeutic change. This is a sample with a fairly low level of symptomatology; in particular, for CAP, more studies are needed to show its relevance on sticker samples (Kramer, Drapeau et al., 2009; Perry et al., 2008).


Ueli Kramer

University of Lausanne