Orta Doğu Teknik Üniversitesi, Ankara
Bölünme, duygulanım düzensizliği, kimlik karmaşası, dürtüsel davranışlar ve kısa psikoz benzeri
epizodlar, klinik alanda yaygın görülen borderline kişilik örüntüsünün temel özelliklerinden bazılarıdır.
Borderline kişilik örgütlenmesinin yapısında bulunan tutarsız kişilerarası ilişkiler, aşırı olumlu ve olumsuz
sınırlar arasında gidip gelen duygulanım düzensizliği ve dürtüsel davranışlar, bölünmüş bilişsel
temsiller veya ikili düşünce tarzından ortaya çıkan kutuplaşmış deneyimlerle ilişkilendirilmektedir. 21
yaşında, üniversite öğrencisi olan Ahmet Y., yukarıda bahsi geçen özellikler doğrultusunda değerlendirilmiş
ve kişilik örgütlenmesinde borderline yapının baskın olduğu düşünülmüştür. Bu nedenle, Ahmet
Y.’nin psikoterapi sürecinde borderline örüntünün temelini oluşturan bölünme mekanizması hedef
alınmıştır. Bölünme, psikodinamik yönelime göre, bebeklikteki dil-öncesi dönemde bakım veren
kişiyle yaşanan iyi ve kötü deneyimlerle bağlantılı olduğundan, kişilerarası ilişkiler açısından oldukça
güçlü bir süreci temsil etmektedir. Ancak kişi sağlıklı bir psikolojik gelişim göstermediğinde, yetişkinlik
döneminde de dış dünyayı bahsedilen ilkel temsillerle algılama ve tanımlama eğilimini korumakta;
böylece gelişmemiş, ayrık ve uç noktalardaki temsiller kişinin yetişkinlik döneminde de bir bütün
haline gelememektedir. Bahsedilen bu kutuplaşmanın, borderline kişilik örüntüsünün temelini oluşturması
nedeniyle, birbirine yakınlaştırılması ya da birleştirilmesi psikoterapi sürecinde önemli bir yere
sahiptir. Bu gelişmiş seviyeye ulaşabilmek için, tedavi sürecinde hastayla iyi bir terapötik ilişki
içerisinde olan terapist, hastanın getirdiği güncel konuları ve geçmiş yaşantıları netleştirmeli (clarification),
gerekli yerlerde hastayı yüzleştirmeli (confrontation) ve yaşantıları etkili bir şekilde birbiriyle
ilişkilendirip yorumlamalıdır (interpretation).
Splitting Mechanism in Borderline Personalities and Psychotherapy Process:A Case Example
The term “borderline” refers a great diversity between one thing and another in a level of
organization. Borderline spectrum extends from the border with the neuroses to border with the
psychoses, and thus the term of borderline came into use (McWilliams, 2010). Borderline personality
traits consists of such symptoms, splitting, affects dysregulation, identity disturbance, impulsive
behaviors, and brief, psychotic-like episodes.
Ahmet Y., 21 year-old university student, applied psychotherapy to resolve his depressive symptoms
and suicide thoughts. However, during sessions it was monitored that he had experienced
intense abandonment fears and inappropriate anger, even when faced with a realistic separation or
when there are unavoidable changes in plans. Although he has talked about abandonment fears
which are related to an intolerance of being alone, he has made an excessive effort to be alone
because he has believed that if he becomes close with somebody, he/she will want to control or
abandon him suddenly due to his own “bad” self. When Ahmet Y. could not solve this conflict
efficiently and defined himself as an “evil” or “bad”, in order to relieve he has displayed recurrent
suicidal behaviors and threats, and self-mutilating acts like cutting his fingers. Because of these
clinical features, it was thought that Ahmet Y.’s personality pattern had been dominated by borderline
personality traits.
Splitting Mechanism
The most fundamental mechanism of primitive defense is splitting the root of borderline
personality (Koenigsberg et al., 2000). According to psychodynamic orientation, splitting which
refers interpersonally powerful process is concerned with object relations consisting of good and
bad experiences with caregivers during the preverbal period in infancy. Before object or self
constancy is achieved in the early stages of the life, infants tend to perceive different experiences
with others as totally separate and distinct from one another. Depending on good-enough nurture,
adults can integrate good and bad in a realistic mix, they can deal with the complexities of the
world due to such integrated internal images in mind. However, borderline patients often perceive
and describe others through those primitive representations of others.
Ahmet Y., who has displayed rapidly shifting moods, intense anger, fear of abandonment
and the unstable interpersonal relationships, has experienced confusion about his life goals. He
could easily shift his mood from happy to desperate or to anger. Moreover, he reported that he
could become very angry in a short time because of any reason, and when he was angry; although
he has had abandonment fear, he could injure somebody or damage something without thinking
consequence of his behaviors. Therefore, his interpersonal relationship has fluctuated back and
forth in an extreme point and so he could define idealized other self as “bad” suddenly.
Therapy Process
The aim of the therapy was to establish an integrated, complex and positively valued sense
of self in a structure. Moreover, due to therapy it is expected that Ahmet Y. has been gained ability
to tolerate and regulate a wide range of emotions, and love other people fully in spite of their flaws
and contradictions (McWilliams, 2011).
Establishing therapeutic relationship with the case of Ahmet Y. was the initial point of his
therapy process. In addition to effectiveness of therapeutic relationship, when tackling splitting,
becoming aware of this thinking style and its harmful implications are so important (Beck et al.,
2004). After recognition, in order to resolve paradox, BPD patients need to reach synthesis and
integration that occurs when polarity is transcended (Linehan, 1993). To achieve this, the therapist
should use clarification in which unclear or confusing information is clarified, confrontation which
consists of bringing to patient’s attention elements of his thoughts, feelings, and behaviors, and
interpretations which make use of the information elicited through other two techniques (Koenigsberg
et al., 2000).
Due to this process, Ahmet Y. could handle on that issue in his real life. Although the
process was not completed, Ahmet Y. began to say “I have a new emotion that is related with
maturation I think. You are the most annoying person in my life while I know that at the same time
you are the most understanding person for me. Now I accept that having some negative characteristics
does not mean that person is bad. Now I began to understand my self-worth is not related
with others’ attitude toward me, I want to accept myself as valuable because I think that I am
valuable with all my emotions and desires.”
Summary
Splitting Mechanism in Borderline Personalities and Psychotherapy Process:
A Case Example
Incila Gürol
Middle East Technical University
Borderline Personality Traits and The Case of Ahmet Y.
The term “borderline” refers a great diversity between one thing and another in a level of
organization. Borderline spectrum extends from the border with the neuroses to border with the
psychoses, and thus the term of borderline came into use (McWilliams, 2010). Borderline personality
traits consists of such symptoms, splitting, affects dysregulation, identity disturbance, impulsive
behaviors, and brief, psychotic-like episodes.
Ahmet Y., 21 year-old university student, applied psychotherapy to resolve his depressive symptoms
and suicide thoughts. However, during sessions it was monitored that he had experienced
intense abandonment fears and inappropriate anger, even when faced with a realistic separation or
when there are unavoidable changes in plans. Although he has talked about abandonment fears
which are related to an intolerance of being alone, he has made an excessive effort to be alone
because he has believed that if he becomes close with somebody, he/she will want to control or
abandon him suddenly due to his own “bad” self. When Ahmet Y. could not solve this conflict
efficiently and defined himself as an “evil” or “bad”, in order to relieve he has displayed recurrent
suicidal behaviors and threats, and self-mutilating acts like cutting his fingers. Because of these
clinical features, it was thought that Ahmet Y.’s personality pattern had been dominated by borderline
personality traits.
Splitting Mechanism
The most fundamental mechanism of primitive defense is splitting the root of borderline
personality (Koenigsberg et al., 2000). According to psychodynamic orientation, splitting which
refers interpersonally powerful process is concerned with object relations consisting of good and
bad experiences with caregivers during the preverbal period in infancy. Before object or self
constancy is achieved in the early stages of the life, infants tend to perceive different experiences
with others as totally separate and distinct from one another. Depending on good-enough nurture,
adults can integrate good and bad in a realistic mix, they can deal with the complexities of the
world due to such integrated internal images in mind. However, borderline patients often perceive
and describe others through those primitive representations of others.
Ahmet Y., who has displayed rapidly shifting moods, intense anger, fear of abandonment
and the unstable interpersonal relationships, has experienced confusion about his life goals. He
could easily shift his mood from happy to desperate or to anger. Moreover, he reported that he
could become very angry in a short time because of any reason, and when he was angry; although
he has had abandonment fear, he could injure somebody or damage something without thinking
consequence of his behaviors. Therefore, his interpersonal relationship has fluctuated back and
forth in an extreme point and so he could define idealized other self as “bad” suddenly.
Therapy Process
The aim of the therapy was to establish an integrated, complex and positively valued sense
of self in a structure. Moreover, due to therapy it is expected that Ahmet Y. has been gained ability
to tolerate and regulate a wide range of emotions, and love other people fully in spite of their flaws
AYNA Klinik Psikoloji Dergisi
2014, 1(1), 1-12 Incila Gürol
12
and contradictions (McWilliams, 2011).
Establishing therapeutic relationship with the case of Ahmet Y. was the initial point of his
therapy process. In addition to effectiveness of therapeutic relationship, when tackling splitting,
becoming aware of this thinking style and its harmful implications are so important (Beck et al.,
2004). After recognition, in order to resolve paradox, BPD patients need to reach synthesis and
integration that occurs when polarity is transcended (Linehan, 1993). To achieve this, the therapist
should use clarification in which unclear or confusing information is clarified, confrontation which
consists of bringing to patient’s attention elements of his thoughts, feelings, and behaviors, and
interpretations which make use of the information elicited through other two techniques (Koenigsberg
et al., 2000).
Due to this process, Ahmet Y. could handle on that issue in his real life. Although the
process was not completed, Ahmet Y. began to say “I have a new emotion that is related with
maturation I think. You are the most annoying person in my life while I know that at the same time
you are the most understanding person for me. Now I accept that having some negative characteristics
does not mean that person is bad. Now I began to understand my self-worth is not related
with others’ attitude toward me, I want to accept myself as valuable because I think that I am
valuable with all my emotions and desires.