Therapist’s defense mechanisms and their relationship with change in patient’s defensive functioning during psychoanalysis

Aim: Research largely study the role of defense mechanisms in psychotherapy. The relationships between defense mechanisms and mental health have been widely demonstrated, but less is known about the role of therapist’s defenses in promoting changes in patient’s defensive functioning. The present study focused for the first time on therapist’s defense mechanisms activated throughout the course of a psychoanalytic treatment and analyzed their relationships with changes in patient’s defensive functioning assessed at different time of the treatment. Methods: Three trained raters coded defense mechanisms using the Defense Mechanisms Rating Scales (DMRS) on transcripts of 20 psychoanalytic sessions collected in five times of the treatment. For each session we coded both therapist’s and patient’s defense mechanisms, with particular attention to the qualitative sequence of defenses consecutively activated within the therapeutic pair. Results: Patient’s defensive functioning tend to gradually improve over the course of psychoanalysis, with a slight decrease at the end of the treatment. As expected, therapist’s overall defensive functioning (ODF) remains stable throughout the treatment with values in the range of highly adaptive defensive functioning. Qualitative analyses showed that the patient tends to activate the same defense mechanisms activated by the therapist more in the initial phases of the treatment. Through the end of the psychoanalysis, patient-therapist defense match decreased while the patient’s ODF becomes more adaptive and individualized. Conclusion: The qualitative and quantitative assessment of defenses in use in the present single case of analytic treatment showed that there is an interaction between therapist-patient in-session defense use. Results says that patient imitates the therapist's ways of defending initially, whereas later there is "individualization" in that patient starts to use their own defenses as a function of development of subjectivity. Further research is needed to confirm the attachment-individuation hypothesis that will be tested in a bigger sample of analytic treatments.