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Tijdschrift voor Psychiatrie 55 (2013) 4, 247 - 257

New research

Defence style and therapeutic technique as predictors of the outcome of psychodynamic psychotherapy in depression

M. Hendriksen, J.J.M. Dekker, F.E.R.E.R. de Jonghe, C.M.T. Gijsbers van Wijk, J. Peen, H.L. Van

background In psychodynamic psychotherapy it is assumed that insight-fostering interventions lead to better results when used with patients who have relatively strong personality structures.
aim To investigate to what extent the use of supportive or insight-fostering interventions is determined by sociodemographic variables, the severity, duration and recurrence of depression and defence style and to find out whether the type of intervention used can predict the treatment outcome of psychotherapy in depression.
method The study-group consisted of 147 depressed patients with or without a comorbid personality disorder who had been treated with supportive PsychoDynamic Therapy (pdt) with or without medication and for whom the Therapist Evaluation Form (tef) was available. On the tef the therapist assessed the patients’ defence style and the therapeutic technique that was used. The most important outcome measure was the Hamilton Depression Rating Scale (ham-d).
results No correlation was found between technique used and sociodemographic characteristics or the severity and duration of the depression. Insight-fostering interventions were related to better treatment outcomes. Not only age and educational level but also defence style turned out to be confounding variables in the relationship between technique and outcome. We found no interaction between treatment success and insight-fostering interventions in patients who used mature defence styles.
conclusion In our study it was defence style as evaluated by the therapist rather than the technique used which was the strongest independent predictor of a successful outcome. This indicates that patients with primitive defence styles may also benefit from insight-fostering interventions.

keywords defence style, depression, outcome, psychodynamic psychotherapy, technique