Free explainer2 min readNICE NG78 (borderline personality disorder, 2009 updated); RCPsych psychotherapy competencies guidance
Psychodynamic concepts: transference, countertransference and defence mechanisms
Understand the model, recognise it in a stem, separate the look-alikes, then apply it.
01Memory anchor
Grade the defences with the ladder: Psychotic-level (denial of external reality, distortion) at the bottom, then Immature (splitting, projection, denial, acting out), then Neurotic (displacement, repression, intellectualisation, reaction formation) in the middle, then Mature (sublimation, humour, altruism, suppression) at the top. Remember PIN-M for the four rungs: Psychotic, Immature, Neurotic, Mature - low rungs distort reality more and appear earlier in development or in more severe illness.