Contribution of defensive functioning to the quality of working alliance and psychotherapy outcome.

We analyzed whether defense mechanisms changed and/or predicted outcome during brief dynamic psychotherapy (N = 43, max 40 sessions, Norwegian Multisite Study on Process and Outcome of Psychotherapy). Defenses were rated with the Defense Mechanism Rating Scales (DMRS, clinician-rated) and Defense Style Questionnaire (DSQ self-rated). Overall defensive functioning (ODF) as rated by DMRS changed significantly. We found that the initial ODF's neither predicted the quality of working alliance nor influenced the outcome. Symptoms improved most rapidly early in therapy, while defenses changed during the last half of therapy, consistent with the phase model of change.