Wild thoughts searching for a thinker. A clinical application of W.R. Bion's theories

This paper describes the results and implications of an 8-year audit cycle concerning premature termination of treatment in a population with severe personality disorder treated within a specialist residential setting. The results of the first audit showed (a) a high early dropout rate, (b) a significant difference in early dropout rates between the two clinical programmes (one-stage and step-down) offered by the unit, and (c) a higher attrition of non-borderline personality disorders compared to borderline type disorder. Qualitative analysis of interviews with early dropout patients helped to identify deficiencies in practice, which may have contributed to dropout. Discussion of results amongst the team led to corrective measures that allowed reduction of early dropout in the one-stage programme over the subsequent years. The implications of the results are discussed.