Supportive psychotherapy and defense mechanisms: A Comment on the case of Matilde

The “Case of Matilde” provides us with an important example of how the in-depth study of a single psychotherapy case can shed light on concepts that lie at the very heart of the psychotherapy debate. The therapeutic relationship, patient defense mechanisms, and therapeutic technique are foundational elements of psychodynamic psychotherapy, understanding their interaction will help guide research and practice. Although the case study enjoyed a central role in the early days of psychotherapy research, randomized controlled trials (RCTs) have replaced case studies as the “gold standard” of empirical psychotherapy research. Nonetheless, Di Riso, Colli, Chessa, Marogna, Condino, et al. (2011) offer a comprehensive analysis that allows readers to get a true sense of what transpires at the clinical level, without ignoring the need for reliable measurement of psychotherapeutic phenomenon. The first issue of clinical relevance in this case is whether or not Matilde actually received strictly “supportive psychotherapy” during her treatment.