During psychodynamic psychotherapy, a patient with borderline personality disorder praises the therapist as the only person who truly understands her, but after a scheduling change, she angrily declares the therapist is completely incompetent and uncaring. Which defense mechanism is the patient exhibiting?
- A Splitting ✓
- B Projective identification
- C Idealization
- D Acting out
Correct answer: A. Splitting
Explanation
Splitting is a primitive defense mechanism where the self or others are viewed as all good or all bad, failing to integrate positive and negative qualities. The rapid shift from idealization to devaluation is characteristic. Idealization is only half the picture. Projective identification involves attributing one's own unacceptable feelings to others. Acting out involves unconscious impulses expressed through actions rather than words.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.
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