Békés Vera, Aafjes-van Doorn Katie, Spina Daniel, Talia Alessandro, Starrs Claire J, Perry J Christopher
Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, United States.
Department of Clinical Psychology, Pennsylvania State University, University Park, PA, United States.
Front Psychol. 2021 Sep 27;12:648503. doi: 10.3389/fpsyg.2021.648503. eCollection 2021.
Despite many theoretical and clinical writings, the theorized connection between defense mechanisms and adult attachment in depressed patients has received little empirical attention. This is the first study to examine patients' defense mechanisms in relation to their attachment in a clinical sample of depressed patients and also the first to use observer-rated measures for assessing both defense mechanisms and attachment. In this pilot study, we aimed to investigate the relationship between patients' attachment and their use of defense mechanisms in psychotherapy sessions, as well as patterns of change over treatment. We conducted a secondary analysis of data from a randomized controlled trial of 30 patients receiving psychotherapy for major depression. Session transcripts were previously coded for defense mechanisms using the Defense Mechanisms Rating Scales, and depression severity data were collected by the clinician-rated HRSD-17 and the self-report BDI-II. Patients' attachment was assessed in two transcripts, one in an early session and a second in a late session, using the novel observer-rated Patient Attachment Coding System. In contrast with expectations, in the early phase of therapy, preoccupied attachment-related characteristics were significantly positively related to overall defensive functioning and negatively related to Depressive immature defenses. In the late phase of treatment, preoccupied attachment-related characteristics were negatively correlated with Non-depressive immature defenses. Moreover, as expected, early-phase defense use was related to late phase attachment; specifically, early neurotic and immature Depressive and Non-depressive defenses predicted an increase in avoidant, whereas immature Non-depressive defenses predicted a decrease in preoccupied attachment-related characteristics over the course of treatment, after controlling for early attachment effects. The results imply a longitudinal relationship between defenses and change in attachment-related characteristics over the course of treatment in a depressed sample and warrant further research about the relationship between defenses and attachment during psychotherapy.
尽管有许多理论和临床著作，但抑郁患者防御机制与成人依恋之间的理论联系很少受到实证关注。这是第一项在抑郁患者临床样本中研究患者防御机制与其依恋关系的研究，也是第一项使用观察者评定量表来评估防御机制和依恋的研究。在这项初步研究中，我们旨在调查患者在心理治疗过程中的依恋与其防御机制使用之间的关系，以及治疗过程中的变化模式。我们对一项针对30名重度抑郁症患者接受心理治疗的随机对照试验的数据进行了二次分析。会话记录先前使用防御机制评定量表对防御机制进行了编码，抑郁严重程度数据由临床医生评定的HRSD - 17和自我报告的BDI - II收集。使用新颖的观察者评定的患者依恋编码系统在两份记录中评估患者的依恋，一份是早期会话记录，另一份是晚期会话记录。与预期相反，在治疗早期，与过度依恋相关的特征与整体防御功能显著正相关，与抑郁性不成熟防御负相关。在治疗后期，与过度依恋相关的特征与非抑郁性不成熟防御负相关。此外，正如预期的那样，早期防御机制的使用与后期依恋有关；具体而言，在控制早期依恋效应后，早期神经质和不成熟的抑郁性及非抑郁性防御预测了回避型依恋的增加，而不成熟的非抑郁性防御预测了治疗过程中过度依恋相关特征的减少。结果表明，在抑郁样本中，防御机制与治疗过程中依恋相关特征的变化之间存在纵向关系，有必要进一步研究心理治疗期间防御机制与依恋之间的关系。
