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The standardization and measurement of defenses is always important, but particularly so at present. An ad hoc committee is currently 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 introduction 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 excellent historical review of Sigmund Freud's concepts of defense mechanisms, 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 chapter is clinical and addresses the “management” of immature defenses in the treatment of patients with lower-level personality disorders. Vaillant views these treatments as multimodal, utilizing psychodynamic and cognitive/behavioral techniques in individual, family, and group formats.
In the book's second section, Empirical Studies, Vaillant is joined by other authors. Chapter 5, “The Struggle for Empirical Assessment of Defenses,” written 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, presents a Defense Style Questionnaire (DSQ), a self-report instrument that presumably elicits the conscious derivatives of unconscious defense mechanisms. That is its main weakness. The