Change in Defense Mechanisms During Long-Term Dynamic Psychotherapy and Five-Year Outcome

Patients treated in dynamic psychotherapy for depressive, anxious, or personality disorders were assessed over the course of their 5-year therapy for their use of defense mechanisms. Patients generally progressed from immature defenses, such as acting out, image distortion, and disavowal, to more neurotic defenses, such as displacement, dissociation, and intellectualization, and then to highly adaptive defenses, such as sublimation and humor. However, the majority of defenses remained below the healthy-neurotic range. Sexual abuse and witnessing violence were associated with slower improvement. Changes in defenses at 2.5 years were associated with improvement in functioning and symptoms at 5 years.