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Objective: Ego defense mechanism (EDM) recognition can offer a powerful and practical tool in clinical psychiatry. However, recognition skill learning can be difficult to assess and may account for the lack of formal EDM recognition training in residency courses.
Method: This study hypothesized that mean test scores would increase significantly over 8 weeks in a course on practical EDM recognition. Second-year residents from two successive classes (n = 25) were tested in the first and the last course sessions using a 10-item, multiple-choice test. Correct answer mean scores were compared using Student's t test.
Results: Test scores demonstrated an increase in the mean percentage of correct answers between the two time points: 54% versus 82%.
Conclusions: These data suggest that clinical EDM recognition can be systematically taught and that learning can be measured appropriately.
Academic Psychiatry 2005; 29:474-478
Studies on ego defense mechanisms (EDMs) have established them as observable phenomena and demonstrated their relation to measurable aspects of health and illness (1, 2). Among other things, empirical research on EDMs has found that adolescent defenses used in adolescence predict health in adulthood (3), that immature defenses such as hypochondriasis are associated not with specific forms of "psychosomatic" illness but with chronic illnesses of many types (4), and that flexible adaptations can be thwarted by conditions that affect brain function (5, 6).
Early psychoanalysis itself paid little attention to EDMs because they could be observed only when deployed and appeared to have little to do with the process of understanding the unconscious (7). The same characteristics in our day offer ways of recognizing changes in brain function (8), improvement or worsening in psychological health status (9), and healing in response to psychotherapy, or medication treatments, or both (10). For many, however, EDMs appear to be theoretical research constructs or psychodynamic theories more than clinically applicable tools. In part, this may be due to the lack of systematic teaching for residents and others in the techniques involved in EDM recognition and use.
This report focuses on a simple question: can EDM recognition be taught? It presents data from successive classes of psychiatric residents who participated in a course that presented a clinical method of recognition of EDMs. The working hypothesis for this project asserted that...