Perspectives
2025: Online Advance Publication
Revisiting defense mechanisms in contemporary clinical practice: evidence and perspectives
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 22 December 2025
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The paper revisits defense mechanisms as central regulators of emotional life and self-coherence in contemporary clinical practice, showing how a classical psychodynamic construct has evolved into an empirically measurable, transdiagnostic dimension of functioning. After outlining the historical development of the concept, the authors present the hierarchical model of defenses, operationalized through the Defense Mechanisms Rating Scale (DMRS), as the current reference framework for assessment of thirty individual defenses across seven levels of adaptiveness. Empirical studies using the DMRS – also in its observer-rated Q-sort and self-report versions – indicate that shifts toward more mature defenses predict better outcomes across different treatment orientations, suggesting that changes in defensive functioning may represent a common factor underlying psychotherapeutic change. These advances are integrated with dimensional and transdiagnostic approaches, including the Psychodynamic Diagnostic Manual, Third Edition (PDM-3), in which defenses play a pivotal role in evaluating personality organization on Axis P and mental capacities on Axis M, thereby complementing symptom-focused systems such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and the International Classification of Diseases (ICD-11). The paper also discusses conceptual overlaps with coping and emotion regulation, the limitations of cross-sectional and self-report methodologies, and the need for longitudinal, cultural, and neuro-psychodynamic research, proposing defense mechanisms as a unifying language that links psychodynamic theory, empirical psychology, and neuroscience.
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Revisiting defense mechanisms in contemporary clinical practice: evidence and perspectives. (2025). Research in Psychotherapy: Psychopathology, Process and Outcome. https://doi.org/10.4081/ripppo.2025.877
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