Specificities of defense mechanisms in bipolar affective disorder: relations with symptoms and therapeutic alliance.
Defense mechanisms as a central notion of psychoanalysis have inspired various levels of interest in research in psychotherapy and psychopathology. Defense specificities have only recently been investigated systematically with regard to several clinical diagnoses, such as affective and personality disorders. For the present study, 30 inpatients diagnosed with Bipolar Affective Disorder I (BD) were interviewed. An observer-rater method, the Defense Mechanisms Rating Scales (DMRS), applied to session-transcripts, of assessment of defenses was used. A matched, nonclinical control group was introduced. Defense specificities in BD encompass a set of 5 immature defenses, of which omnipotence is linked with symptom level. The level of the therapeutic alliance is predicted by mature defenses. These results are discussed with regard to the psychological vulnerability of BD, and treatment implications for psychodynamic psychotherapy with such challenging patients are evoked.
Kramer
Ueli
U
Departments of Psychology, University Hospitals of Lausanne, University of Lausanne, Switzerland. Ueli.Kramer@chuv.ch
de Roten
Yves
Y
Perry
J Christopher
JC
Despland
Jean-Nicolas
JN
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D003674:Defense Mechanisms; D005260:Female; D006760:Hospitalization; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology; D010555:Personality Inventory / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011594:Psychometrics; D013811:Psychotherapeutic Processes; D011613:Psychotherapy / Q000379:methods*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires