Ego Psychology

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EGOMECHANISMS OF DEFENSE: A GUIDE FOR CLINICIANS AND RFSURCH-
EM. By George E. Vailtant. M‘ashington, D C h e r . Psychiat. Press,
1992,306 pp., $38.50.

The standardization and measurement of defenses is always im-

portant, but particularly so at present. An ad hoc committee is cur-
rently working on a possible sixth axis of defense mechanisms, to be
brought back to the DSM-IV Multiaxial Issues Workshop. Were such
an axis to be developed, it would represent the first significant intro-
duction of psychodynamic material into the DSM. Thus, the book
under review here is indeed timely.
Its first section, Clinical Applications, is primarily theoretical and
consists of four chapters by George E. Vaillant. The first is an excel-
lent historical review of Sigmund Freud’s concepts of defense mecha-
nisms, his early attention to specific defenses, a subsequent relative
disinterest, and a recrudescence of his interest in 1926.In the second
chapter Vaillant argues for the crucial role of defense mechanisms
in diagnosis and treatment. Chapter 3 addresses the importance of a
uniform nomenclature of defenses; psychodynamic researchers have
more or less achieved consensus among themselves, but there is little
agreement between them and cognitive psychologists. The final c h a p
ter is clinical and addresses the ‘gmanagementOof immature defenses
in the treatment of patients with lower-level personality disorders.
Vaillant views these treatments as multimodal, utilizing psychody-
namic and cognitive/behavioral techniques in individual, family, and
group formats.
In the book‘s second section, Empirical Studies,Vaillant isjoined
by other authors. Chapter 5, “The Struggle for Empirical Assessment
of Defensesss9written by Vaillant, is a historical review. In Chapter 6,
Vaillant and Vaillant present data demonstrating that the maturity
or immaturity of defensive style is not influenced by economic status,
education, social privilege, or IQ. Michael Bond, in Chapter 7, pres-
ents a Defense Style Questionnaire (DSQ), a self-report instrument
that presumably elicits the conscious derivatives of unconscious de-
fense mechanisms. That is its main weakness. The DSQ rather than
measuring specific defense mechanisms, instead addresses “defense
styles” grouped into maladaptive, imagedistorting, self-sacrificing,
and adaptive styles. In Chapter 8 the Vaillants, studying the same

Dr. Rockland is Director of the Adult Psychiauy Clinic, New York Hospital,
Wcstchester Division, White Plains, New York
 Book Reviews
I
subjects six eight years apart, compare the results obtained using
to
their clinically derived rating scales with those afforded by the DSQ.
In Chapter 9, Leigh McCullough discusses methodological a p
proaches for improving the reliability of defense mechanism ratings.
Jacobson et al., in Chapter 10, use clinical interviews to evaluate de-
fense mechanisms in adolescents. In Chapter l l , Perry and Cooper
describe the Defense Mechanism Rating Scales (DMRS), their devel-
opment, and subsequent studies of their reliability and validity. “Im-
mature” and “imagedistorting” defenses were associated with
increased symptomatology and psychosocial impairment, “border-
line” defenses predicted greater psychosocial impairment, but neu-
rotic defenses correlated neither with symptoms nor with
psychosocial difficulties. Roston, Lee, and Vaillant, in the book’s final
chapter, compare three methodologies for assessing defenses: Bond’s
DSQ, clinical assessment, and a Q-sort approach.
Extremely useful appendices contain the DSM-III-R Glossary of
Defense Mechanisms, Meissner’s and Vaillant’s glossaries of defenses,
Perry’s DMRS, the Ego Defense Mechanisms Manual of Jacobson et
al., Bond’s DSQ and Vaillant’s modification of the Haan Q-sort.
A problem with the book is that areas of controversy are almost
never identified as such. For example, the various lists of defenses
commingle defense mechanisms with what Wallerstein (1983) has
characterized as defensive behaviors. Vaillant, fully aware of this dis-
tinction, choscs to ignore it (p. 8 ) ; elsewhere the issue is accorded
not even this summary treatment. For Wallerstein, defense mecha-
nisms are basic modes of the mind’s operation that are unconscious;
defensive behaviors derive from them. For instance, projection and
repression are fundamental defense mechanisms. Passive aggression,
by contrast, is a behavioral style or DSM-III-R personality disorder;
though used defensively, it is not itself a defense mechanism.
A related problem is the qualification of basic defense mecha-
nisms by their end results. For example, Vaillant differentiates delu-
sional projection from projection per se. T h e expression of any
defense mechanism is of course influenced by the level of thc charac-
ter structure through which it is expressed, but the mechanism re-
mains the same. Projection is projection, whether or not it leads to
psychotic experience.
Inclusion in these lists of the mature group of defenses, or c o p
ing mechanisms, is also debatable. Although the empirical adkantages
of including a mature defensive style are clear, the theoretical con-
struct of defense mechanism is thereby compromised. For example,
suppression contains elements of conscious decision making, and
 Ego Psychology

anticipation might better be conceptualized as an ego function; while

both may be used defensively, they are not themselves defense mccha-
nisms.
A fourth problem area is the use of idiosyncratic definitions.
For example, the equation of hypochondriwis with “helprejecting
complaining” would not likely meet with general agreement from
clinicians. Surprisingly, Perry and Cooper’s “hypochondriasis” can
dispense with somatic symptoms entirely.
Finally, much of the book was previously published as Empirical
Studies of Ego Mechanistas of Defeme, a Clinical Insights Monograph
edited by Vaillant and published by American Psychiatric Press in
1986. Most of the book‘s second half is camed over from the mono-
graph, with only a few of the papers updated or significantly revised.
Similarly, MO of the four Vaillant chapters have appeared elsewhere.
The resulting collection would have been strengthened by a final
chapter by Vaillant, summarizing the work of the other contributors,
their similarities and differences, and issues for further study.
These criticisms aside, the book affords the reader an excellent
overview of current thinking regarding the nomenclature, measure-
ment, and rclebance of defense mechanisms. It may be recommended
to all professionals interested in defenses-that is, to all psychody-
namic clinicians and researchers.

REFERENCE
R S. (1983).Defense, defense mechanisms, and the structure of the
WALLERSTEIN,
mind. J. A w . PgchoanaL Assn.. 31(Suppl.):201-225.

Lawrence H. Rockland, M.D.

White Plains, New York