Identifying Psychotic Defenses in a Clinical Interview

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,...

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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
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Abstract	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.
AbstractList	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. 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. [PUBLICATION ABSTRACT]
Author	Berney, Sylvie Despland, Jean-Nicolas de Roten, Yves Kramer, Ueli Beretta, Véronique
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References_xml	– year: 2011 – year: 1984 – volume: 12 start-page: 288 year: 2005 end-page: 296 article-title: Changes of defensive functioning. Does interpretation contribute to change? publication-title: Clinical Psychology and Psychotherapy – volume: 66 start-page: 1232 year: 2010 end-page: 1241 article-title: Change in defense mechanisms and coping over the course of short‐term dynamic psychotherapy for adjustment disorder publication-title: Journal of Clinical Psychology – volume: 10 start-page: 155 year: 2001 end-page: 164 article-title: Contribution of patient defense mechanisms and therapist interventions to the development of early therapeutic alliance in a Brief Psychodynamic Investigation publication-title: Journal of Psychotherapy Practice and Research – volume: 197 start-page: 675 year: 2009 end-page: 681 article-title: Specificities of defense mechanisms in bipolar affective disorder. Relations with symptoms and therapeutic alliance publication-title: Journal of Nervous and Mental Disease – volume: 169 start-page: 916 year: 2012 end-page: 925 article-title: Change in defense mechanisms during long‐term dynamic psychotherapy and five‐year outcome publication-title: American Journal of Psychiatry – volume: 13 start-page: 366 year: 2011 end-page: 370 article-title: Involuntary coping mechanisms: A psychodynamic perspective publication-title: Dialogues in Clinical Neuroscience – volume: 38 start-page: 236 year: 2005 end-page: 258 article-title: EASE: Examination of anomalous self‐experience publication-title: Psychopathology – year: 2001 – volume: 75 start-page: 331 year: 2012 end-page: 341 article-title: Supportive psychodynamic psychotherapy versus treatment as usual for first‐episode psychosis: Two‐year outcome publication-title: Psychiatry – volume: 24 start-page: 107 year: 1971 end-page: 118 article-title: Theoretical hierarchy of adaptive ego mechanisms publication-title: Archives of General Psychiatry – volume: 50 start-page: 412 year: 2011 end-page: 424 article-title: Metacognition in schizophrenia: The relationship of mastery to coping, insight, self‐esteem, social anxiety, and various facets of neurocognition publication-title: British Journal of Clinical Psychology – volume: 29 start-page: 133 year: 2009 end-page: 144 article-title: L’étude des mécanismes de defense psychotiques: Un outil pour la recherche en psychothérapie psychanalytique [Studying psychotic defense mechanisms: a tool for performing research in psychoanalytic psychotherapy] publication-title: Psychothérapies – volume: 191 start-page: 496 year: 2003 end-page: 502 article-title: A study of stability and change in defense mechanisms during a Brief Psychodynamic Investigation publication-title: Journal of Nervous and Mental Disease – year: 1990 – year: 1994 – volume: 58 start-page: 1159 year: 2010 end-page: 1188 article-title: Toward developing a scale to empirically measure psychotic defense mechanisms publication-title: Journal of the American Psychoanalytic Association – volume: 35 start-page: 5 year: 2009 end-page: 8 article-title: Subjective symptoms of schizophrenia in research and the clinic: The basic symptom concept publication-title: Schizophrenia Bulletin – volume: 42 start-page: 283 year: 2009 end-page: 292 article-title: The phenomenological model of psychotic vulnerability and its possible implications for psychological interventions in the ultra‐high risk (prodromal) population publication-title: Psychopathology – volume: 193 start-page: 136 year: 2005 end-page: 139 article-title: An investigation of tasks and techniques associated with dynamic interview adequacy publication-title: Journal of Nervous and Mental Disease
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SubjectTerms	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
Title	Identifying Psychotic Defenses in a Clinical Interview
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