ArticlesA Pilot Study of Defenses in Adults with Personality Disorders Entering PsychotherapyPERRY, J. CHRISTOPHER M.P.H., M.D.1,2Author Information 1McGill University Department of Psychiatry at the Institute of Community & Family Psychiatry, Sir Mortimer B. Davis - Jewish General Hospital, 4333 chemin de la côte Ste-Catherine, Montréal, Québec H3T 1E4 Canada. 2The Erikson Institute for Education and Research of the Austen Riggs Center, Stockbridge, Massachusetts 01262-0962. Send reprint request to Dr. Perry (either address). The data collection was supported by a grant from the National Institutes of Mental Health Number R01 MH40423 while the author was at the Cambridge Hospital. An early version of this was presented at the Annual Meeting of the American Psychiatric Association, Philadelphia, Pennsylvania, May 22 to 26, 1994. Special thanks goes to those who participated as raters at both institutions. The Journal of Nervous and Mental Disease: October 2001 - Volume 189 - Issue 10 - p 651-660 Buy Abstract This study examined defensive functioning in adults entering open-ended dynamic psychotherapy and determined whether defenses predict retention at 1 year. Beginning at about the fifth session, 14 adults with personality and or depressive disorders entering open-ended dynamic psychotherapy had five therapy sessions audiotaped. The sessions were rated according to the Defense Mechanism Rating Scales, quantitative method. Interrater reliability of overall defensive functioning (ODF) and the number of defenses used per session were intraclass R = .85 and .83, respectively, whereas that of seven defense levels yielded a median of .625 (range .52 to .80). Stability of ODF across the five sessions was intraclass R = .48. The 11 subjects with personality disorders (PDs) used predominantly lower immature (49.3%) and neurotic (40.8%) level defenses. Subjects with borderline PD had significantly lower ODF than those with other PD types. Higher ODF was associated with remaining in treatment at 1 year, although this was confounded with a higher frequency of weekly sessions. Quantitative assessment of defenses demonstrated fair to excellent reliability and indicated that in the short term approximately half of defensive functioning reflects a stable repertoire, whereas the remaining variation may be due to occasion and error. PDs and especially BPD are characterized by a predominance of lower defenses. Higher defensive functioning was associated with twice-weekly sessions and retention in therapy at 1 year. In therapy, adjusting technique to the patient's defenses may improve retention and outcome. © 2001 Lippincott Williams & Wilkins, Inc.