The Concept of Defense Mechanisms in Contemporary Psychology

Uwe Hentschel Gudmund J.W. Smith Wolfram Ehlers Juris G. Draguns Editors

The Concept of Defense Mechanisms in Contemporary Psychology

Theoretical, Research, and Clinical Perspectives

With 51 Illustrations

Springer-Verlag New York Berlin Heidelberg London Paris Tokyo Hong Kong Barcelona Budapest

Uwe Hentschel, Ph.D., Departmel.lt of Personality Psychology, University of Leiden, 2300 RB Leiden, The Netherlands

Gudmund J. W. Smith, Ph.D., Department of Psychology, University of Lund, S-22350 Lund, Sweden

Wolfram Ehlers, M.D., Center for Psychotherapy Research, D-70597 Stuttgart 70, Germany

Juris G. Draguns, Ph.D., Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA

Library of Congress Cataloging-in-Publication Data The Concept of defense mechanisms in contemporary psychology:

theoretical, research, and clinical perspectives / Uwe Hentschel ... let al.], editors.

p. cm. Includes bibliographical references. ISBN-13: 978-1-4613-8305-5 e-ISBN-13: 978-1-4613-8303-1 DOl: 10.1007/978-1-4613-8303-1 1. Defense mechanisms (Psychology) I. Hentschel, Uwe. [DNLM: 1. Defense Mechanisms. WM 193 C744]

BF175.5.D44C66 1993 155.2-dc20 92-48254

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Preface

What is the scientific status and the "truth value" of the concept of defense mechanisms? Among contemporary psychologists, three types of answers to this question may be expected. Some would wholeheartedly endorse the theoretical, clinical, and research value of this notion; others would reject it outright. Between these two extremes, a large number of observers, perhaps the majority, would suspend their judgment. Their attitude, compounded of hope and doubt, would capitalize on defense as an interesting and promising concept. At the same time, these psy­chologists would express skepticism and disappointment over its clinical limitations, theoretical ambiguity, and research failures.

The present volume is primarily addressed to the audience of hopeful skeptics-those who have not given up on the notion of defense, yet have been frustrated by the difficulties of incorporating it into the modern, streamlined structure of psychology. To this end, we have brought together theoretical and empirical contributions germane to defense together with reports about their applications to clinical and personality assessment, especially in relation to psychopathology, psychosomatics, and psycho­therapeutic intervention.

The idea for this volume originated at the 24th International Congress of Psychology in Sydney, where the four editors found themselves at the Symposium on Experimental Psychodynamic Research. Members of the audience asked about the availability of a systematic and up-to-date overview of this topic, and it became apparent that there was no such resource in the current or recent literature. As we immersed ourselves in this topic, we became aware of the magnitude and difficulty of the task. Above all, decisions about inclusion and exclusion had to be faced and the recurrent question about where to draw the line had to be answered. Our response was to concentrate on percept-genetic techniques, clinical ratings, personality questionnaires, and projective tests. We also allocated some space to speech samples and psychophysiological indicators in relation to defenses. In this manner, we ended up with 28 contributions. Their collective and principal objective is to highlight the advantages and

v

VI Preface

the potentials of the currently active approaches to empirical research on defense mechanisms. At the same time, we have endeavored not to hide the unsolved problems and the inherent difficulties and limitations of this research area.

The results of these studies are varied. The method specificity of a great many findings is evident. To overcome these limitations, we have included nine theoretically oriented chapters, which we hope will be help­ful in articulating the theoretical issues and the conceptual assumptions that are shared by the contributors to the volume. Although the chapters can be read separately, in any order, we recommend that the reader new to this field turn to Chapter 7, especially if he or she desires an intro­duction to the percept-genetic approaches. In any case, the chapters are extensively cross-referenced so that the readers can easily turn their sights from theory to research and vice versa.

Conceived at an international congress, the present volume has retained a cosmopolitan outlook. Contributions from the United States, Great Britain, Sweden, Germany, Israel, Chile, and the Netherlands are in­cluded. Inevitably, a high proportion of the chapters are written by authors who are not native speakers of English. As editors, we have tried to keep in mind the problems that have resulted from this circumstance and to improve the clarity and usage of the text whenever we could. We can only hope that these efforts have been reasonably successful, and we apologize to our readers for any avoidable peculiarities and idiosyncrasies that we have failed to spot.

The boundaries of the concept of defense are fuzzy, and unsolved problems and unanswered questions abound. The four editors, however, share the conviction that there is enough validated and applicable infor­mation to sustain the interest of both basic researchers and practitioners and to justify the pursuit of the theoretical and empirical objectives posited in this book. What fascinates us-and we hope to transmit our enthusiasm to some of our readers-is the possibility of merging the psy­chodynamic and the experimental traditions of investigation. Our belief is that this merger is one of the waves of the future in psychology. If so, we hope that this book will serve as an invitation to develop new avenues of experimental psychodynamic investigation and to refine and extend the existing approaches.

We are grateful to all the contributors who have complied with the difficult conditions inherent in delivering an electronically stored manu­script. Our thanks go to the editors and employees at Springer-Verlag, especially for allowing us more pages than originally allocated, and to the Swedish Council for Humanistic and Social Science Research for the financial support extended to this project. Last but not least, we thank several people who have helped us in the production process: M. Weijand for coordinating and correcting work, G. Veltema and A. Wentzel for

Preface vii

retyping parts of the text and the tables, and M. Echteld for preparing some of the figures in Harvard Graphics.

Uwe Hentschel Gudmund J. W. Smith

Wolfram Ehlers Juris G. Draguns

Contents

Preface Contributors Introduction

Part I General Issues

v

xvii xxi

1. A Critical Perspective on Defense Mechanisms . . . . . . . . . . . . . . . . . . . . 3 Paul Kline

Freudian Psychoanalytic Defense Mechanisms. . . . . . . . . . . . . . . . . . . . . 3 The Work of Vaillant and Horowitz. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Conclusions .................................................. 11 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

2. Defense Mechanisms in the Clinic and in the Laboratory: An Attempt at Bridging the Gap. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Juris G. Draguns

Early Formulations and Conceptual Developments. . . . . . . . . . . . . . . . . 14 Contributions of Ego Analysts: Anna Freud and Others ............ 15 Conceptual Revisions and Modifications. . . . . . . . . . . . . . . . . . . . . . . . . . 16 Defenses as Predictable and Observable Variables: From the Clinic to

the Laboratory. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Unanswered Questions: Future Research Objectives . . . . . . . . . . . . . . . 21 References ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

3. What Is a Mechanism of Defense? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Hans Sjobiick

References ......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

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4. Percept-Genesis and the Study of Defensive Processes. . . . . . . . . . . . . . 38 Bert Westerlundh

Microgenesis, Percept-Genesis, and the Theory of Perception. . . . . . . 38 Schools and Research Paradigms of Microgenesis . . . . . . . . . . . . . . . . . . 39 The Perceptual Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Parallelisms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Determinants of the Percept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 The Technique of Information Reduction. . . . . . . . . . . . . . . . . . . . . . . . . 42 The Theory of Defense. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Modification of the Classical Theory ............................. 44 Percept-Genesis and the Study of Defensive Processes. . . . . . . . . . . . . . 45 Validity of the Percept-Genetic Approach. . . . . . . . . . . . . . . . . . . . . . . . 46 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Part II Methodological Considerations

5. The Measurement of Defense Mechanisms by Self-Report Questionnaires. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Uwe Hentschel, Wolfram Ehlers, and Rainer Peter

The Historical Roots of Defense Mechanisms: A Concept Formulated Without Any Intent of Its Quantification or Experimental Testing.. . . .. . . .. . .. .. . .. ... ... . .. ... .. .. .. . .. ... ... . .. . . .. . 53

The Full Scope of the Defensive Process and Different Methods for Its Registration ............................................. 55

Questionnaires and the Theory of Psychometric Measurement. . . . . . . 59 On the Theoretical Background for the Construction of Different

Self-Report Questionnaires for Measuring Defense .............. 61 Theoretical and Empirical Implications for Regarding Defense as a

Complex Construct . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 The Implications of the Complex Model Interpretation of Defense for

Further Research. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

6. The Assessment of Primitive Defense Mechanisms by Projective Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Falk Leichsenring

The Empirical Assessment of Defense Mechanisms ................ 88 The Assessment of Low Level Defense Mechanisms by Means of the

Rorschach and the Holtzman Inkblot Technique. . . . . . . . . . . . . . . . . 89 References ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

Contents XI

7. Percept-Genetic Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

Gudmund J. W. Smith and Uwe Hentschel

The Defense Mechanism Test (DMT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 The Meta-Contrast Technique (MCT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 DMT and MCT: A Comparison................................. 117 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118

8. The Study of Defenses in Psychotherapy Using the Defense Mechanism Rating Scales (DMRS) .............................. 122 J. Christopher Perry, Marianne E. Kardos, and Christopher J. Pagano

Description of the Defense Mechanism Rating Scales. . . . . . . . . . . . . . . 122 Potential Significance of Studying Defenses in Psychotherapy. . . . . . . . 130 References .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Part III Personality and Applied Psychology

9. Causal Attributions of Disease as Related to Dynamic Personality Variables. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Gudmund J. W. Smith and Gunilla van der Meer

Method...................................................... 135 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145

10. Exploration of the Relationship Between Anxiety and Defense: Semantic Differential Ratings of Defense Mechanism Test Stimuli. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Juris G. Draguns

The Experiment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Method..... .... .................................. ....... .... 148 Results...... .... ... ... ......... .... ............ ... .... ... ... . 149 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 References '" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151

11. The Cognitive Determinants of Defense Mechanisms. . . . . . . . . . . . . . . 152 ShuZamith KreitZer and Hans KreitZer

Cognitive Precursors of Defense Mechanisms ..................... 152 Belief Constellations Conducive to Defense Mechanisms. . . . . . . . . . . . 154 Defense Mechanisms as a Specific Kind of Programs ............... 157

xii Contents

Predicting the Application of Defense Mechanisms. . . . . . . . . . . . . . . . . 160 Cognitive Dynamics Underlying Defense Mechanisms. . . . . . . . . . . . . . 164 The Meaning System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Patterns of Meaning Variables and Defense Mechanisms. . . . . . . . . . . . 168 Beliefs and Meaning Variables as Predictors of Defenses. . . . . . . . . . . . 174 Modifying Defense Mechanisms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176 Summing Up and Some Afterthoughts ........................... 177 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

12. Development of the Repression-Sensitization Construct: With Special Reference to the Discrepancy Between Subjective and Physiological Stress Reactions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Carl-Walter Kohlmann

Multiple Variable Approaches with Traditional Instruments. . . . . . . . . 187 The Discrepancy Hypothesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 Person-Oriented Approaches ................................... 194 Concluding Remark ........................................... 198 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198

13. Augmenting/Reducing: A Link Between Perceptual and Emotional Aspects of Psychophysiological Individuality . . . . . . . . . . . . . . . . . . . . . . 205 Fernando Lolas

Classical Notions of Augmenting/Reducing .... . . . . . . . . . . . . . . . . . . . 205 Recent Work. ... ... .. ..... ...... . .............. .............. 206 References .................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

14. A Psychodynamic Activation Study of Female Oedipal Fantasies Using Subliminal and Percept-Genetic Techniques . . . . . . . . . . . . . . . . . 209 Bert Westerlundh

Hypotheses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Man Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Woman Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Method...................................................... 213 Results....................................................... 216 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220 References .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

15. Aspects of the Construct Validity of the Defense Mechanism Test. . . . 225 Barbara E. Saitner

Method...................................................... 226 Research Design .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Results and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Conclusion ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232

Contents xiii

16. Adaptation to Boredom and Stress: The Effects of Defense Mechanisms and Concept Formation on Attentional Performance in Situations with Inadequate Stimulation . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 Uwe Hentschel, Manfred Kief3ling, and Am Hosemann

Method...................................................... 236 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248

Part IV Clinical Assessment and Psychotherapeutic Interventions

17. The Structure and Process of Defense in Diagnosis of Personality and in Psychoanalytic Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Wolfram Ehlers

Clinical Definitions of Defense Mechanisms. . . . . . . . . . . . . . . . . . . . . . . 254 The Structure of Diagnostic Evaluations of Defense Mechanisms. . . . . 255 Personality Diagnosis as a Determinant of Defense Structure. . . . . . . . 260 Defense Variables of the Process in Psychoanalytic Treatment. . . . . . . 263 References ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

18. The Measurement of Ego Defenses in Clinical Research . . . . . . . . . . . . 275 Hope R. Conte and Robert Plutchik

Variations in the Concept of Ego Defenses. . . . . . . . . . . . . . . . . . . . . . . . 275 The Life Style Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277 Conclusions and Directions for Future Research . . . . . . . . . . . . . . . . . . . 286 References ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287

19. Validation of the German Version of Bond's Questionnaire of Defensive Styles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290 Gerhard Reister, Rolf Manz, Roland Fellhauer, and Wolfgang Tress

The German Version of the Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . 291 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294 References ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295

20. Regulative Styles and Defenses: Some Relationships Between the Serial Color-Word Test and the Defense Mechanism Test. . . . . . . . . . . 296 l. Alex Rubino and Nicola Ciani

Method...................................................... 298 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300

XIV Contents

Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308

21. Change in Defense Mechanisms Following Intensive Treatment, As Related to Personality Organization and Gender. . . . . . . . . . . . . . . . 310 Phebe Cramer and Sidney 1. Blatt

Method...................................................... 312 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314 Discussion. .. . . .. . . . . .. . . . . . . . . . . . . .. . .. . ... ... .. .. . .. . .. . . .. . 317 References .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319

22. Defense Mechanisms in Interaction with Intellectual Performance in Depressive Inpatients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321 Uwe Hentschel, Manfred Kief3ling, Heidi Teubner-Berg, and Herbert Dreier

Method............... ....................................... 324 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335

23. Defense Mechanisms and Hope as Protective Factors in Physical and Mental Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339 Louis A. Gottschalk and lanny Fronczek

Methods and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353 Summary and Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356

24. Defense Mechanisms in Patients with Bone Marrow Transplantation: A Retrospective Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360 Christina Schwilk, Daniela Aeschelmann, Horst Kiichele, Claudia Simons, and Renate Arnold

Theoretical Considerations and Guiding Questions. . . . . . . . . . . . . . . . . 360 Method...................................................... 361 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369

Contents xv

Part V Psychosomatics

25. Attitudes Toward Illness and Health and Defense Mechanisms in Psychosomatic Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373 Frits J. Bekker, Uwe Hentschel, and Marion Reinsch

Aim and Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 384 Concluding Remarks. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386 References ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386

26. Anorexics and Bulimics Compared Vis-a-Vis Defense, Proximity, and Separation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389 Per Johnsson

Method...................................................... 391 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395 Discussion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400

27. Defense Styles in Eating Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404 Inez Gitzinger

Why Is It Important To Look at Defense and Coping? . . . . . . . . . . . . . . 404 Differences in Defense Styles in Eating Disorders: How Can They Be

Studied? ................................................... 404 Participants. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405 The Instrument for Studying Defenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 406 Questions Addressed in This Study .............................. 407 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410

28. Defense Mechanisms and Defense Organizations: Their Role in the Adaptation to the Acute Stage of Crohn's Disease. . . . . . . . . . . . . . . . . 412 Joachim Kuchenhoff

The Heidelberg Research Project on Crohn's Disease. . . . . . . . . . . . . . 412 Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414 Summary and Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419 References ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422

Index 425

Contributors

Daniela Aeschelmann, Department of Psychotherapy, University of Ulm, D-7900 Ulm, Germany

Renate Arnold, M.D., University Hospital, D-7900 Ulm, Germany

Frits J. Bekker, Ph. D., Department of Personality Psychology, University of Leiden, 2300 Leiden, The Netherlands

Sidney J. Blatt, Ph.D., Department of Psychiatry, Yale University, New Haven, cr 06520, USA

Nicola Ciani, M.D., Department of Psychiatry, Torvergata University, 00100 Rome, Italy

Hope R. Conte, Ph. D. , Albert Einstein College of Medicine of Yeshiva University, Bronx, NY 10461, USA

Phebe Cramer, Ph.D., Department of Psychology, Williams College, Williams­town, MA 01267, USA

Juris G. Draguns, Ph.D., Department of Psychology, The Pennsylvania State University, University Park, PA 16802, USA

Herbert Dreier, Department of Psychology, University of Mainz, D-6500 Mainz, Germany

Wolfram Ehlers, M.D., Center for Psychotherapy Research, D-70597 Stuttgart 70, Germany

Roland Fel/hauer, Gelderland Clinic, D-4170 Geldern, Germany

Janny Fronczek, Department of Psychonomics, University of Amsterdam, 1018 WB Amsterdam, The Netherlands

xvii

xviii Contributors

Inez Gitzinger, Ph. D., Werner Schwidder Clinic for Psychosomatic Medicine, 7812-Bad Krozingen, Germany

Louis A. Gottschalk, M. D., Ph. D., Department of Psychiatry and Human Behavior, College of Medicine, University of California, Irvine, CA 92717, USA

Uwe Hentschel, Ph.D., Department of Personality Psychology, University of Leiden, 2300 RB Leiden, The Netherlands

Arn Hosemann, Ph.D., Daimler Benz Research Institute, D-lOOO Berlin, Germany

Per Johnsson, Department of Psychiatry, University of Lund, S-22185, Lund, Sweden

Horst Kiichele, M.D., Department of Psychotherapy, University of Ulm, D-7900 Ulm, Germany

Marianne E. Kardos, The Cambridge Hospital, Cambridge, MA 02139, USA

Manfred Kiej3ling, Gesellschaft zur F6rderung Pers6nlichkeits- und Sozialpys­chologisches-Forschung, University of Mainz, D-6500 Mainz, Germany

Paul Kline, Ph.D., D.Sc., Washington Singer Laboratories, Department of Psy­chology, University of Exeter, Exeter EX44QG, England

Carl-Walter Kohlmann, Ph.D., Institute of Psychology, University of Mainz, D-6500 Mainz, Germany

Hans Kreitler, Ph.D., Department of Psychology, Tel Aviv University, 69978 Tel Aviv, Israel (deceased)

Shulamith Kreitler, Ph.D., Department of Psychology, Tel Aviv University, 69978 Tel Aviv, Israel

Joachim Kuchenhoff, Ph.D., Psychosomatic Clinic, University of Heidelberg, D-6900 Heidelberg 1, Germany

Falk Leichsenring, Ph.D., Department of Clinical Group Psychotherapy, Uni­versity of G6ttingen, D-3400 G6ttingen, Germany

Fernando Lolas, M. D., Psychiatric Clinic, University of Chile, Santiago 7, Chile

Contributors xix

Rolf Manz, Department of Psychotherapy, University of Heidelberg, D-6900 Heidelberg, Germany

Christopher J. Pagano, Ph.D., The Cambridge Hospital, Cambridge, MA 02139, USA

J. Christopher Perry, Ph.D., Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec H3T 1E4, Canada

Rainer Peter, Center for Psychotherapy Research, D-70oo Stuttgart 70, Germany

Robert Plutchik, Ph.D., Albert Einstein Cpllege of Medicine of Yeshiva Univer­sity, Bronx, NY 10461, USA

Marion Reinsch, Department of Personality Psychology, University of Leiden, 2300 Leiden, The Netherlands

Gerhard Reister, M.D., Department of Psychosomatic Medicine and Psychother­apy, Heinrich Heine University, D-4000 Dusseldorf 12, Germany

I. Alex Rubino, M.D., Percept-Genetic Laboratory, Torvergata University, 00141 Rome, Italy

Barbara E. Saitner, Ph.D., University of Cologne, 5000 Koln 41, Germany

Christina Schwilk, M.D., Department of Psychotherapy, University of Ulm, D-7900 VIm, Germany

Claudia Simons., Department of Psychotherapy, University of UIm, D-79oo UIm, Germany

Hans Sjobiick, Ph.D., Department of Psychology, University of Lund, S-22350 Lund, Sweden (deceased)

Gudmund J. W. Smith, Ph. D., Department of Psychology, University of Lund, S-22350 Lund, Sweden

Heidi Teubner-Berg, Gesellschaft zur Forderung Personlichkeits- und Sozialpys­chologisches-Forschung, University of Mainz, D-65oo Mainz, Germany

Wolfgang Tress, M.D., Ph.D., Department of Psychosomatic Medicine and Psy­chotherapy, Heinrich Heine University Dusseldorf, D-40oo Dusseldorf 12, Germany

xx Contributors

Gunilla van der Meer, Department of Psychology, University of Lund, S-22350 Lund, Sweden

Bert Westerlundh, Ph.D., Department of Psychology, University of Lund, S-22350 Lund, Sweden

Introduction: Defense Mechanisms in Clinical Practice, Theoretical Explanation, and Experimental Investigation UWE HENTSCHEL, GUDMUND J.W. SMITH, WOLFRAM EHLERS, and JURIS G. DRAGUNS

Over the last few years, the concept of defense mechanism has increas­ingly come into focus both in theory and in empirical investigation. No longer the virtually exclusive concern of psychoanalytically oriented clinicians, defense mechanisms are demonstrating their usefulness over a wide spectrum of areas of interest to both theoreticians and practitioners in the behavioral sciences. Such popularity has brought with it prob­lems and difficulties. The defense enterprise runs the risk of becoming unwieldy and amorphous. Defenses have come to mean very different things to different people, and the concept may become so vague as to be nonfalsifiable-retroactively invoked with impunity, yet of little use in formulating specific and differential predictions. The number of desig­nated defense mechanisms has been increasing exponentially, and their applications have been expanding in all directions, from the consulting rooms of psychoanalysts to the training programs of fighter pilots.

What then is the justification for yet another book about defense mechanisms? Certainly, there has been no paucity of such publications. Like many other concepts, mechanisms of defense have gone through a lengthy process of gestation and maturation. Originally a cornerstone of psychoanalytic conceptualization, they have entered everyday speech, as exemplified by such common phrases in several Western languages as "I must have simply repressed it." Academic psychologists have variously ignored the concept of defense, scrutinized it skeptically, or accepted it with reservations. The related concept of coping has enjoyed more success, less burdened as it is by the assumption of the unconscious. Since the two concepts are closely, perhaps even inextricably connected, their somewhat diverging fortunes exercise pressure upon the field to decide between acceptance and rejection. As already suggested, in the last few years the scale has been tipped toward an ever more general, though as yet not universal, acceptance. The formulations within the DSM-IV, currently in the prefinal stages of its development, testify to the trend of incorporating the notion of defense into diagnostic formulations and criteria. Numerous attempts have been undertaken to capture general

xxi

xxii Introduction

defensiveness or specific defenses by means of paper-and-pencil scales. Interdisciplinary connections have been forged, on the conceptual and empirical levels, between differences across persons and stimuli in adapt­ive performance, implicit in the notion of defense, and trends and con­cepts in biology and medicine that are focused on the subject. Hentschel, Smith, and Draguns (1986) have noted the parallels between percept­genetic assumptions, prominent in the current investigation of defense mechanisms, and the notions of functional region discussed by von Uexkiill (1921) and the Gestaltkreis as treated by von Weizsacker (1947). A noteworthy trend in contemporary biology is focused on the personal history of the subject or its epigenesis in the constant interplay of per­sonal experience, behavior, and environment. Thus Maturana and Varela (1988) speak of drift in the course of the simultaneous and bilateral interchange which affects the subject and the environment alike.

As Hernandez Peon, Scherrer, and Velasco (1956) have demonstrated, the afferent conduction from the peripheral parts of the nervous system can be dependent on central influences that comprise the subjective emotional experiences. These observations, once again, highlight the importance of the subject, in both theory and experimentation. And yet, the notion of the subject remains too global and holistic to be con­veniently incorporated into empirical research. The challenge is to delimit more specific variables of predictive value. Defense mechanisms hold promise in this respect, for several reasons. For one, they constitute a psychodynamic concept that encompasses the naturally occurring uncon­scious and affective contents of human information processing, so often artificially excluded in the interest of "neat and tidy" experimentation. Moreover, inferences can be made from the momentary manifestation of defense to the more abiding, structural characteristics of the individual. Defenses span the range of maladaptive to adaptive behavior, and at the same time they represent an empirically observable and measurable concept. The potential attractiveness of the concept of defense then lies in its scope: from the neuronal substrate to complex real-life events. Defense mechanisms are embedded in the social representation of various actions and conceptions, and they are crucial in coping with reality. To be sure, they could be more "neatly" classified and arranged; there are too many similar labels and diverging operational definitions.

In this volume, we grouped the chapters into five major sections, corresponding to, besides general issues, four areas of empirical research and application, namely methodological considerations, personality and applied psychology, clinical assessment and psychotherapeutic interven­tion, and psychosomatic research. These four sections are preceded by a set of chapters that provide a general introduction and, above all, present the theoretical underpinning for the understanding of the concept of the defense as well as the rationale for the several styles and modes of its current investigation.

Introduction XXlll

Of necessity, we have started at the source; defense mechanisms were discovered and described in the psychotherapeutic setting. From there they traveled to the experimental laboratory and came to be observed, assessed, and manipulated in a variety of practical contexts. And yet the progression has never been unidirectional: experimental observations have informed clinical practice, and practical findings have been brought to bear upon theoretical formulations. At this point, we are witnessing an especially lively interchange among theoreticians, researchers, and practitioners. The present volume is testimony to the vitality of this interaction. Our hope is that it may not only document it, but foster and promote its growth and cultivation.

The variety of the current research methods and tools makes an exhaus­tive categorization difficult. Nonetheless, the several types of investigation can be organized under the following headings: clinical observations, self­report inventories, projective techniques, and percept-genetic methods. Cutting across this fourfold scheme is the contrast between observational and correlational studies on the one hand and of those based on experi­mental control and manipulation on the other. Research on defense mechanisms has gone beyond observation and recording, and its present state testifies to the feasibility of predicting the occurrence of defense, under experimental or naturalistic conditions.

So far, this preview of the volume's content has been grounded in general considerations, within psychology and beyond it. We should not, however, forget that the concept of defense originated and developed within a specific theoretical context, that of psychoanalysis. It therefore behooves us to bridge the gap between the origins of the concept and its current differentiated state in contemporary psychoanalysis.

The shift from the id to the ego has paved the way for psychoanalysis to come into contact with the concepts of contemporary psychology and other related sciences that deal with human experience. In the late writings of S. Freud the far-reaching effects of psychoanalysis are found by applications of psychoanalysis in all social sciences: "Strictly speaking there are only two sciences: psychology, pure and applied, and natural science" (Freud, 1933, p. 1).

From 1945 to 1970 Hartmann, the leading theoretician in the post­Freudian days, emphatically asserted that psychoanalysis must become a general psychology (Hartmann, 1964). Murphy (1960) was also emphatic in asserting that psychoanalysis should provide a unified theory of be­havior without literal adherence to Freud's formulations. The structure of contemporary psychoanalytic theory can be described by some relevant perspectives in psychology.

The interpersonal perspective in psychoanalysis focuses attention on a larger transactional field by including cultural, societal components in the developmental, operationally oriented scheme. Empirical psychoanalytic research includes interpersonally defined mechanisms of defense like

XXIV Introduction

archaic or early defense mechanisms (see Chapters 17 and 28 in this book). Projective identification is a good example of the expanding con­cept of defense in interpersonal communication. Sandler (1987) described three stages for the development of this defense concept. In the first stage Klein's (1946) original definition of projective identification focused on the person's fantasy life: "Much of the hatred against parts of the self is now directed towards the mother. This leads to a particular form of identification which establishes the prototype of an aggressive object­relation. I suggest for these processes the term 'projective identification.' When projection is mainly derived from the infant's impulse to harm or to control the mother, he feels her to be a persecutor" (Klein, 1946, p. 102). In the second stage Heimann (1950), Racker (1968), and Grinberg (1962) substantially extended projective identification by bringing it into conjunction with the analyst's identification with the self- or object rep­resentation in the patient's unconscious fantasies, and with its effect on countertransference. The countertransference reaction could then be a possible source of information for the analyst about what was occurring in the patient. The central contribution of the third stage of development is the container model of Wilfred Bion (1962, 1963), which describes the capacity of the caretaking mother to be attentive to and tolerant of the needs, distress, and anger as well as the love of the infant, and to convey reassurance that she can both contain these feelings and respond to them in a considered and appropriate way. Through this the infant learns that his or her distress is not catastrophic. In the analytic situation the patient, in a similar way, can learn that those parts that he or she had considered to be dangerous can be accepted as aspects of the self that are not harmful.

The structural system of 1923 replaced the topographic system of Freud from 1900. Gill (1963) and Arlow and Brenner (1964) devoted extensive work to this point. Peterfreund (1971) argued that the traditional formu­lations of ego psychology and structural hypotheses lack explanatory power. Their replacement by information processing and systems models must restore consistency with neurophysiology. Moser (1968) with his cognitive model of defense gave an example for the conceptual inte­gration of defense into contemporary cognitive psychology. In the present volume, Gottschalk and Fronczek (Chapter 23), Lolas (Chapter 13), and Kohlmann (Chapter 12) have made contributions toward integrating psychophysiological methods and findings into the study of defense.

The replacement of the drive concept by modern formulation of emo­tion theory (Dahl, 1991) makes new research designs possible in the realm of general and clinical psychology, as exemplified by Krause and Liitolf (1988) in their study on affect regulation in psychoanalytic treatment.

Models of the mind (Gedo & Goldberg, 1973) show that different concepts of metapsychology are relevant for developmental stages in the process of psychotherapy. The developmental perspectives of defense

Introduction xxv

should stimulate a reconceptualization of defense mechanisms as they occur in psychotherapy. Perry, Kardos, and Pagano have initiated this effort in Chapter 8. The assumption of a hierarchical order of defense mechanisms constructed on a continuum from very pathological to ma­ture, which by the empirical studies of Vaillant (1974) so strongly has improved the validity of the concept in general, does not make redundant the continued need for elaborated definitions of specific mechanisms and efforts to reach a widely accepted consensus on these (cf. Vaillant, 1992).

Once again, we return then to a fundamental theme: how the concept of defense has radiated from its origins in psychotherapy to be brought to bear upon the elucidation of the therapy situation. Without neglecting the psychotherapeutic focus, however, we have deliberately cast the net as widely as possible, in conceptualizations, approaches, methods, and topics. In the process, we have become aware of the limits of the present state of knowledge about defenses.

As yet, there is no way of comparing the manifestations of defense mechanisms across the various methods used for their observation. Con­versely, with methods held constant, the several mechanisms cannot be conclusively and objectively compared. In light of these limitations, what is the incremental information that the book is able to provide? We think that the specific applications underscore the potentialities and the limits of the various methods and thereby delimit the frontiers of knowledge. For example, it is not necessary to have a constant standard of comparison to be able to determine which defense mechanisms promote the healing process in bone marrow transplant patients or what defenses enhance attention deployment.

The focus of the book is on the content of the various problems investigated. We have not, however, neglected methodological consider­ations, but we have not reached the point of being able to recommend one model research design for the study of defense mechanisms. The time is not yet ripe for a definitive evaluation of defense-oriented re­search. This situation is not that different from natural sciences (e.g., biomedicine, in which customarily the method of data gathering and evaluation is incorporated into the report of the results). In psychology, this problem is exacerbated by the linguistic dependence of its constructs. In any case, the empirical study of defense appears to us to be such an exciting and significant enterprise that we felt compelled to emphasize the multitude of the current research approaches. As editors, we have adopted the role of reporters in limiting ourselves to the communication of a complex pattern in as realistic a manner as we could.

References Arlow, I.A. & Brenner, C. (1964) Psychoanalytic concepts and the structural

theory. Madison, CT: International Universities Press.

XXVI Introduction

Bion, W.R. (1962) Learning from experience. London: Heinemann. Bion, W.R. (1963) Elements of psychoanalysis. London: Heinemann. Dahl, H. (1991) The key to understanding change: Emotions as appetitive wishes

and beliefs about their fulfillment. In J.G. Safran L. (Ed.), Emotion, psycho­therapy and change (pp. 130-165). New York: Guilford Press.

Freud, S. (1933) The new introductory lectures. In The standard edition of the complete psychological works of Sigmund Freud: Vol. 22. London: Hogarth Press.

Gedo, J.E. & Goldberg, A. (1973) Models of the mind. Chicago: University of Chicago Press.

Gill, M.M. (1963) Topography and systems in psychoanalytic theory. Psychologi­cal Issues: Monogra. 10. Madison, CT: International Universities Press.

Grinberg, L. (1962) On a specific aspect of countertransference due to the patients projective identification. International Journal of Psychoanalysis, 43, 436-440.

Hartmann, H. (1964) Essays in ego psychology. Madison, CT: International Universities Press.

Heimann, P. (1950) On countertransference. International Journal of Psycho­analysis, 31,81-84.

Hentschel, U., Smith, G., & Draguns, J.G. (1986) Subliminal perception, micro­genesis, and personality. In U. Hentschel, G. Smith, & J.G. Draguns (Eds.), The roots of perception: Individual differences in information processing within and beyond awareness (pp. 3-36). Amsterdam: Elsevier.

Hernandez Peon, R., Scherrer, H., & Velasco, M. (1956) Central influences on afferent conduction in the somatic and visual pathways. Acta Neurologica Latina Americana, 2,8-22.

Klein, M. (1946) Notes on some schizoid mechanisms. International Journal of Psychoanalysis, 27,99-110.

Krause, R. & Lutolf, P. (1988) Facial indicators of transference processes within psychoanalytic treatment. In H. Dahl, H. Kachele, & H. Thoma (Eds.), Psychoanalytic process research strategies (pp. 241-256). Berlin: Springer.

Maturana, H.R. & Varela, F.J. (1988) The tree of knowledge. The biological roots of human understanding. Boston: New Science Library.

Moser, U., Zeppelin, I. von, & Schneider, W. (1968) Computersimulation eines Modells neurotischer Abwehrmechanismen. Ein Versuch zur Formalisierung der psychoanalytischen Theorie [Computer simulation of a model of neurotic defense mechanisms. An attempt at formalizing psychoanalytic theory] (Bulletin 2). Department of Psychology, University of Zurich.

Murphy, G. (1960) Psychoanalysis as a unified theory of social behavior. Science and Psychoanalysis, 3, 140-149.

Peterfreund, E. (1971) Information, systems and psychoanalysis. An evolutionary biological approach to psychoanalytic theory. Madison, CT: International Uni­versities Press.

Racker, H. (1968) Transference and countertransference. Madison, CT: Inter­national Universities Press.

Sandler, J. (1987) The concept of projective identification. In J. Sandler (Ed.), Projection, identification, projective identification (pp. 13-26). London: Karnac.

Uexkull, J. von (1921) Umwelt und Innenwelt der Tiere [The environment and inner world of animals]. Berlin: Springer.

Introduction XXVII

Vaillant, G.E. (1974) Adaptation to life. Boston: Little, Brown. Vaillant, G.E. (1992) The historical origin and future potential of Sigmund

Freud's concept of the mechanisms of defense. International Review of Psycho­analysis, 19, 35-50.

Weizsiicker, V. von (1947) Der Gestaltkreis [The gestalt region]. Stuttgart: Thieme.