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It is a pleasure for us to discuss Phebe Cramer's article, “Understanding Defense Mechanisms.” Professor Cramer has an impressive track record when it comes to this subject, including her book, Protecting the Self: Defenses in Action, published in 2006. As a psychologist versed in empirical methodology, she brings to her subject matter not only her understanding but also her implementation of experimental design. Cramer's review of the literature, replete with her own studies of different defenses as well the work of other researchers, notably George Vaillant (1992), is placed at the close rather than the beginning of her essay. And thus it serves as a tacit reminder of what many feel to be missing in most clinical contributions. That is, systematic empirical research using relatively large samples to prove clearly framed hypotheses rather than simply illustrating forgone conclusions with either single case studies or, for that matter, brief vignettes.
While lauding this effort, we will address concerns about content validity when psychological phenomena that occur in nature are operationalized in experimental methodology. We also would add to Cramer's excellent summary of the genesis and function of defenses in adult subjects a developmental perspective on their origination, evolution, and transfiguration during childhood and adolescence. Finally, with this perspective in mind, we would challenge the author's assumption—one that is shared by most dynamic clinicians—that defenses are perforce unconscious. And though this cannot validate hypotheses, we will indeed draw on case material throughout our discussion not to prove but rather to generate hypotheses that subsequently might be subject to systemic empirical verification.