Identifying Psychotic Defenses in a Clinical Interview

• Published in: Journal of clinical psychology Vol. 70; no. 5; pp. 428 - 439
• Main Authors: Berney, Sylvie, de Roten, Yves, Beretta, Véronique, Kramer, Ueli, Despland, Jean-Nicolas
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-05-2014; Wiley Periodicals Inc
• Subjects: Adult; Clinical psychology; Defense Mechanisms; Female; Humans; Interview, Psychological; Male; measurement; Middle Aged; Narratives; Patients; Psychiatric Status Rating Scales; psychodynamic psychotherapy; Psychological tests; psychosis; Psychotic Disorders - psychology; schizophrenia; Schizophrenic Psychology; schizophrenia; psychodynamic psychotherapy; defense mechanisms; measurement; psychosis
• ISSN: 0021-9762; 1097-4679
• DOI: 10.1002/jclp.22087

The Defense Mechanisms Rating Scales (DMRS), one of the most widely used and validated instruments in the study of defense mechanisms, does not include psychotic defenses. The Psychotic‐DMRS (P‐DMRS) has been developed to include 6 psychotic defense mechanisms: psychotic denial, autistic withdrawal, distortion, delusional projection, fragmentation, and concretization. We discuss psychotic defenses, including the difference between psychotic defenses and psychotic symptoms. Six clinical illustrations demonstrate how the 6 P‐DMRS defenses can be identified in patients’ narratives selected from the transcripts of dynamic interviews. Implications with respect to patient evaluation and treatment are discussed.