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).

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.