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

Perry, J. Christopher; Beck, Stephanie; Constantinides, Prometheas; Foley, Joan E.

doi:10.1007/978-1-59745-444-5_6

Cited by 44 publications

(43 citation statements)

References 16 publications

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“…capacity to abstract form the experience, cfr. Mergenthaler 1996; defense mechanisms, Perry et al 2009) or that analyze it in terms of functional characteristics of the process-e.g. in terms of level of alliance between patient and therapist (Colli and Lingiardi 2009;Horvath 2011).…”

Section: Discussionmentioning

confidence: 99%

Psychotherapy Research Needs Theory. Outline for an Epistemology of the Clinical Exchange

Salvatore¹

2011

Integr. psych. behav.

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This paper provides an analysis of a basic assumption grounding the clinical research: the ontological autonomy of psychotherapy-based on the idea that the clinical exchange is sufficiently distinguished from other social objects (i.e. exchange between teacher and pupils, or between buyer and seller, or interaction during dinner, and so forth). A criticism of such an assumption is discussed together with the proposal of a different epistemological interpretation, based on the distinction between communicative dynamics and the process of psychotherapy-psychotherapy is a goal-oriented process based on the general dynamics of human communication. Theoretical and methodological implications are drawn from such a view: It allows further sources of knowledge to be integrated within clinical research (i.e. those coming from other domains of analysis of human communication); it also enables a more abstract definition of the psychotherapy process to be developed, leading to innovative views of classical critical issues, like the specific-nonspecific debate. The final part of the paper is devoted to presenting a model of human communication--the Semiotic Dialogical Dialectic Theory--which is meant as the framework for the analysis of psychotherapy.

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Section: Discussionmentioning

confidence: 99%

Psychotherapy Research Needs Theory. Outline for an Epistemology of the Clinical Exchange

Salvatore¹

2011

Integr. psych. behav.

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“…As such, these biases may contribute to undo depressive realism, or other problem‐solving strategies (Clark et al ., ; Dimaggio et al ., ; Gigerenzer & Brighton, ), while at the same time, they may represent a route to self‐acceptance and increased self‐knowledge, as fostered in psychodynamic treatments (Messer & McWilliams, ). A different explanation may be a possible mediation of cognitive change by changes in underlying defence mechanisms (Perry et al ., ). The overgeneralizing stance may be explained by the underlying self‐observing or intellectualizing defences which both tend to increase across dynamic therapies, in particularly when assessed using consistent in‐session observational coding (Kramer et al ., ; Perry et al ., ).…”

Section: Discussionmentioning

confidence: 97%

“…For 32 patients with adjustment disorder undergoing psychodynamic psychotherapy, Kramer, de Roten, Michel, and Despland (; see also Kramer, Despland, Michel, Drapeau, & de Roten, ) did not find a main effect for coping change; however, they found an interaction between coping change and the therapeutic alliance; for stronger alliances, greater coping change was found in psychodynamic psychotherapy. In a case study, Perry, Beck, Constantinides, and Foley () found a clinically significant change in cognitive variables over the course of psychodynamic psychotherapy. For a short‐term psychiatric–psychodynamic treatment for patients with borderline personality disorder, specific decrease in biased thinking was described in a pilot study by Kramer, Caspar, and Drapeau ().…”

Section: Introductionmentioning

confidence: 99%

The role of cognitive biases in short‐term psychodynamic psychotherapy

et al. 2017

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The concept of biased thinking – or cognitive biases – is relevant to psychotherapy research and clinical conceptualization, beyond cognitive theories. The present naturalistic study aimed to examine the changes in biased thinking over the course of a short‐term dynamic psychotherapy (STDP) and to discover potential links between these changes and symptomatic improvement. This study focuses on 32 self‐referred patients consulting for Adjustment Disorder according to DSM‐IV‐TR. The therapists were experienced psychodynamically oriented psychiatrists and psychotherapists. Coding of cognitive biases (using the Cognitive Errors Rating Scale; CERS) was made by external raters based on transcripts of interviews of psychotherapy; the reliability of these ratings on a randomly chosen 24% of all sessions was established. Based on the Symptom Check List SCL‐90‐R given before and after, the Reliable Change Index (RCI) was used. The assessment of cognitive errors was done at three time points: early (session 4–7), mid‐treatment (session 12–17), and close to the end (after session 20) of the treatment. The results showed that the total frequency of cognitive biases was stable over time (p = .20), which was true both for positive and for negative cognitive biases. In exploring the three main subscales of the CERS, we found a decrease in selective abstraction (p = .02) and an increase in personalization (p = .05). A significant link between RCI scores (outcome) and frequency of positive cognitive biases was found, suggesting that biases towards the positive might have a protective function in psychotherapy. Practitioner points Therapists may be attentive to changes in biased thinking across short‐term dynamic psychotherapy for adjustment disorder. Therapists may foster the emergence of positive cognitive biases at mid‐treatment for adjustment disorder.

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“…Putting issues of practicality aside, we describe one potential experimental design that relies on ecologically valid methodology already available to elicit defenses, to which we add an experimental procedure and fMRI assessment. The Relationship Anecdote Paradigm (RAP) interview is a semi-structured interviewing technique for eliciting interpersonal vignettes (Beck & Perry, 2008), which include the participant's defenses (Perry, Beck, Constantinides, & Foley, 2009). After the story details have been elicited, the interviewer asks three questions that specifically focus on the emotional impact of the vignette on the respondent.…”

Section: Addressing and Interpretingmentioning

confidence: 99%

Addressing and Interpreting Defense Mechanisms in Psychotherapy: General Considerations

Olson

Perry

Janzen³

et al. 2011

Psychiatry: Interpersonal and Biological Processes

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

Cited by 44 publications

References 16 publications

Psychotherapy Research Needs Theory. Outline for an Epistemology of the Clinical Exchange

Psychotherapy Research Needs Theory. Outline for an Epistemology of the Clinical Exchange

The role of cognitive biases in short‐term psychodynamic psychotherapy

Addressing and Interpreting Defense Mechanisms in Psychotherapy: General Considerations

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