An exploratory study of the defence mechanisms used in psychotherapy by adults who have intellectual disabilities.
Adults with intellectual disabilities bring varied defence styles to therapy—give them more than eight sessions to show change.
01Research in Context
What this study did
Researchers watched eight therapy sessions with the adults who have intellectual disabilities.
They tracked every defence mechanism the adults used.
They wanted to see if the defences changed over the first two months of therapy.
What they found
The adults showed many defence styles, not just simple ones.
Some used mature defences like humour.
Their styles stayed the same across the eight sessions.
No one shifted to healthier defences in that short time.
How this fits with other research
La Malfa et al. (2009) found emotional growth links tightly with daily living skills.
That work came one year before this study and helped set the stage for measuring emotions in adults with ID.
Mulder et al. (2020) later showed parents believe kids with ID can do CBT if you adapt it.
This extends the 2010 finding: if children can learn CBT skills, adults can likely learn more complex defences too.
Nijs et al. (2016) proved you can reliably score emotional growth by watching adults directly.
Their method mirrors how the 2010 team coded defences from therapy tapes.
Why it matters
Do not label adults with ID as stuck at primitive defences.
Expect a mix of styles and plan longer therapy arcs.
Track defences monthly, not weekly, to spot real change.
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02At a glance
03Original abstract
PROBLEM: A significant concept in psychodynamic theory and practice is that of defence mechanisms. The identifications of defences is a key task of the therapist and these are then used in the formulation and form part of the therapist's interventions. Case studies of psychotherapy with adults who have intellectual disabilities (IDs) suggest that they use more primitive defences but this has not been empirically evaluated. This study aimed to find out what defences adults with IDs use within and across sessions of individual psychotherapy. METHODS: Transcripts of psychotherapy sessions with a case series of eight adults with IDs were evaluated using the defence mechanism rating scale. RESULTS: Contrary to expectation the participants were observed to use a wide range of defences from primitive to mature. There was evidence to suggest that participants had developed a defensive style, but little evidence to show change in defensive structure across the first eight sessions of treatment. CONCLUSIONS: This exploratory study shows that adults who have IDs use a range of defences in psychotherapy and have particular defensive styles. The results suggest that future studies may need more participants and a longer time frame to see if change in defences occurs during psychotherapy. The defence mechanism rating scale may also need some validation work with adults who have IDs and consider inclusion of some defences that are disability-specific.
Journal of intellectual disability research : JIDR, 2010 · doi:10.1111/j.1365-2788.2010.01250.x