# Situation: The nurse on an acute psychiatric unit uses psychoanalytic and developmental theories to understand clients' behavior. A 34-year-old man often makes cutting remarks about his controlling older brother during family visits. Within an hour after each such remark, he insists on buying his brother a snack from the canteen and says he 'feels settled again' only after giving it. On visits without such a remark, he brings nothing. He never mentions the remarks. Which defense mechanism is he MOST likely using?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630174  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse on an acute psychiatric unit uses psychoanalytic and developmental theories to understand clients' behavior.

A 34-year-old man often makes cutting remarks about his controlling older brother during family visits. Within an hour after each such remark, he insists on buying his brother a snack from the canteen and says he 'feels settled again' only after giving it. On visits without such a remark, he brings nothing. He never mentions the remarks. Which defense mechanism is he MOST likely using?

## 보기

1. Reaction formation
2. Undoing **✔ 정답**
3. Compensation
4. Sublimation

**정답: 2**

## 해설

Undoing is an act performed, without conscious awareness of its purpose, to symbolically cancel a previous unacceptable act or thought. The gift follows each hostile remark and relieves his discomfort, and it does not occur when there has been no remark, which ties it to cancelling that specific act.

## 심화 해설

The defense is undoing
After each cutting remark about his controlling older brother, the client insists on buying his brother a snack and says he "feels settled again" only after giving it. On visits without such a remark, he brings nothing. This is undoing: an act performed, without conscious awareness of its purpose, to symbolically cancel a previous unacceptable act or thought. The tight link between each hostile remark and the following gift, plus the relief he feels afterward, is what identifies undoing.

How undoing works
Undoing reduces the guilt or anxiety produced by an act the person finds unacceptable. The hostile remark creates inner discomfort; the gift "erases" it, and his tension falls. Because the mechanism is unconscious, he does not connect the gift to the remark and never mentions the remarks. The pattern is conditional: the compensating act appears only after the specific act it cancels. Everyday examples include bringing flowers after an argument or becoming extra helpful after a harsh comment, without recognizing the reason.

Comparing similar defenses
Watch out! Reaction formation is the most common distractor here, because both involve behavior that looks opposite to hostility. The difference is timing and consistency.

| Defense | Definition | Why it does or does not fit |
| --- | --- | --- |
| Undoing | An act that symbolically cancels a prior unacceptable act | Fits: the gift follows each remark and relieves his distress |
| Reaction formation | A steady display of the opposite feeling that replaces the unacceptable one | Does not fit: he openly expresses hostility; kindness is not constant |
| Compensation | Making up for a perceived weakness by excelling in another area | Does not fit: no weakness or area of achievement is described |
| Sublimation | Channeling an unacceptable drive into a socially valued activity | Does not fit: the gift cancels a specific act rather than redirecting a drive |

Nursing relevance
Identifying the defense helps the nurse understand the anxiety beneath the behavior. Here the client appears to carry strong, conflicted feelings toward a controlling brother that he cannot express comfortably. The nurse does not interpret the defense to him abruptly. Instead the nurse builds trust and, over time, helps him recognize and put into words his feelings about the brother, so that he can address the relationship more directly. Defense mechanisms become maladaptive when they are used rigidly and prevent the person from dealing with the underlying problem.

Exam takeaway
Key point! Undoing = an act that follows and "cancels" a specific unacceptable act or thought. Reaction formation = a constant opposite attitude that hides the real feeling. Look for the sequence: unacceptable act, then a compensating act, then relief.

## 임상 시나리오

Undoing as a DefenseLinking a gift to each hostile remark
Undoing is an unconscious act that symbolically cancels a previous unacceptable act or thought. He buys a snack only after a cutting remark and then feels settled.

Reaction formation is a steady opposite attitude that hides the real feeling; he expresses hostility openly, so it does not fit.

The nurse builds trust and gradually helps him recognize and express his feelings about his brother rather than interpreting the defense abruptly.

CautionLook for the sequence of act, compensating act, and relief. A gift that appears only after a hostile remark points to undoing, not general kindness.

## 핵심 개념

- **Undoing** — An unconscious defense in which an act is performed to symbolically cancel a previous unacceptable act.
- **Reaction formation** — A defense that replaces an unacceptable feeling with a constant display of its opposite.
- **Compensation** — A defense that makes up for a perceived weakness by excelling in another area.
- **Sublimation** — A defense that channels unacceptable drives into socially valued activities.
- **Unconscious** — Mental processes outside a person's awareness that still influence behavior.

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