Copyright © The British Psychological Society Reproduction in any form (including the internet) is prohibited without prior permission from the Society How to address patients’ defences: A pilot study of the accuracy of defence interpretations and alliance Olivier Junod 1 , Yves de Roten 1 , Elena Martinez 1 , Martin Drapeau 2 and Jean-Nicolas Despland 1 * 1 Institute for Psychotherapy Research, University of Lausanne, Switzerland 2 McGill University & Institute of Community and Family Psychiatry of the SMBD Jewish General Hospital, Canada This pilot study examined the accuracy of therapist defence interpretations (TAD) in high-alliance patients (N ¼ 7) and low-alliance patients (N ¼ 8). TAD accuracy was assessed in the two subgroups by comparing for each case the patient’s most frequent defensive level with the most frequent defensive level addressed by the therapist when making defence interpretations. Results show that in high-alliance patient-therapist dyads, the therapists tend to address accurate or higher (more mature) defensive level than patients most frequent level. On the other hand, the therapists address lower (more immature) defensive level in low-alliance dyads. These results are discussed along with possible ways to better assess TAD accuracy. Over a century ago, Freud (1894) published an article in which he suggested that defence mechanisms are a central aspect of neurotic functioning. In subsequent correspondence with Fliess, he postulated that such defensive manoeuvres are a means of dealing with painful drives, feelings, and thoughts of a mostly sexual nature. A decade later, with the works of Freud (1937), the study of defence mechanisms became a central aspect of psychoanalytic theory and technique. Today, most psychodynamically-oriented therapists would agree on the significance and importance of understanding a patient’s defensive functioning in therapy. This theoretical position undoubtedly raises the question as to how a clinician should deal * Correspondence should be addressed to Jean-Nicolas Despland, Institut Universitaire de Psychothe ´rapie, Rue du Tunnel 1, CH-1005 Lausanne, Switzerland (e-mail: jean-nicolas.despland@chuv.ch). The British Psychological Society 419 Psychology and Psychotherapy: Theory, Research and Practice (2005), 78, 419–430 q 2005 The British Psychological Society www.bpsjournals.co.uk DOI:10.1348/147608305X41317