The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery–Asberg Depression Rating Scale (MADRS). A subsample of 41 patients (19 responders and 22 non-responders) from an RCT was included. For each case, two sessions (the second and the penultimate) of brief inpatient psychodynamic psychotherapy (a manualized 12-session therapy program developed in Lausanne) were transcribed and then coded using the Defense Mechanism Rating Scales (DMRS) and the Psychotic Defense Mechanism Rating Scales (P-DMRS), an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient’s defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy.

Résumé La question épineuse de l’efficacité relative des principales formes de psychothérapies a donné lieu à de très nombreux travaux dont les résultats se sont révélés inconsistants, voire contradictoires et ne font que prolonger, sur un autre plan, les anciens conflits idéologiques entre écoles rivales. Mais vaut-il vraiment la peine de se préoccuper de cette question, sachant, par exemple, que les facteurs qui permettent de prédire le succès thérapeutique concernent bien davantage la relation thérapeutique ou les caractéristiques du thérapeute plutôt que le type de thérapie pratiquée ? Les recherches portant sur les processus thérapeutiques ont clairement montré que l’on ne peut se contenter de catégoriser de manière simpliste des traitements et des troubles si l’on souhaite comprendre dans quelle mesure et pourquoi telle intervention est efficace. Seul un esprit d’ouverture et de collaboration entre cliniciens et chercheurs de différentes écoles permet de faire progresser notre connaissance dans ce domaine.

This article describes the treatment framework and core therapeutic principles of the integrative brief systemic intervention (IBSI), a manualized six‐session intervention intended for parents seeking couple therapy. IBSI aims to work on the couple's presenting problem, considering its specific impact in the marital and coparenting domains. The basic premise of IBSI is to consider that, when working with couples who have children, therapeutic work on their coparenting alliance may be used as a lever, as both parents may be particularly motivated to improve their relationship for their children's benefit. Increasing the coparenting alliance may then facilitate work on deeper conflicts within the marital relationship. The core therapeutic principles of IBSI are: (1) joining with the couple as romantic partners and a coparenting team from the start of the therapeutic process; (2) supporting the parents in increasing their awareness regarding their children's behavior and emotional experiences when facing their parents’ conflicts; and (3) working on the spill‐ and cross‐over effects between marital and coparenting relationships (i.e., exploring how conflict or positivity spills over from one relationship to the other or crosses over from one partner to the other). Therapeutic work following these main therapeutic principles is expected to improve the quality of both relationships. A clinical case is provided to illustrate the core therapeutic principles of IBSI.