Turning against self and its relation to symptom distress, interpersonal problems, and therapy outcome: A replicated and enhanced study

The relation of the turning against self defense mechanism to symptom distress, interpersonal problems, and therapy outcome was explored in 75 inpatients in a psychodynamic setting. In accordance with former studies, the patients showed a high initial level of turning against self, and its reduction during therapy was correlated with a good symptom reduction. The validity of the measurement of this mechanism by the FKBS, a German version of the Defense Mechanisms Inventory, was confirmed by high correlations with scales from the State-Trait Anger Expression Inventory and the Toronto Alexithymia Scale. A new issue was how turning against self correlated with interpersonal behavior. Patients with a frequent use of turning against self had more interpersonal problems, predominantly of the friendly–submissive type and significantly fewer of the domineering–hostile type. Identifying and reducing a strong turning against self, as well as challenging the related interpersonal behavior, thus represent central tasks in psychotherapy. A multimodal inpatient setting with a combination of psychodynamic and behavioral interventions proved to be effective. Finally, the question of favorable therapist variables is raised.