Changes in defensive functioning in a case of avoidant personality disorder

This case study is based upon data from a male patient with Avoidant Personality Disorder who was in psychoanalytic treatment for 5 years. Defense mechanism use was assessed by 3 coders using the Defense Mechanisms Rating Scales. Session transcripts from intake, each year of therapy, and 1-year follow-up were used for the ratings. Over the course of psychoanalysis and follow-up, the patient's Overall Defensive Functioning and High-Adaptive defense level use increased and his use of the Disavowal defense level and Fantasy decreased. The pattern of change throughout treatment was also assessed. The patient's Overall Defensive Functioning decreased initially, followed by an increase through year 4. Overall Defensive Functioning decreased again prior to termination before increasing to its highest level at follow-up. The results demonstrated changes consistent with hypotheses and theory, including overall improvement in defensive functioning, an initial regression of defensive functioning, decline in functioning immediately prior to termination, and continued improvement posttermination. This pattern of defense change highlights the importance of assessing defenses in treatment research.