Surviving as a personality disorder service

Personality disorder services working along psychotherapeutic lines gained appeal with Health Care Commissioners following the publication of the National Institute for Health and Clinical Excellence (NICE) guidelines for Borderline & Antisocial Personality Disorders and the emerging successful application of psychoanalytically derived approaches. In parallel to this creative development, the economic downturn has faced the National Health Service (NHS) with considerable challenges in its ongoing survival. The potential for creative pursuit often then sits in competition, juxtaposed with the need to survive. We examine the impact of this dynamic upon the therapeutic efforts of a newly established personality disorder service. We suggest that both conscious and unconscious aspects stirred up within such encounters are demanding of the need for development of a capacity within each to bear contact with unfamiliar experiences. Through attention to that development, both patient and clinician may further enliven and enrich individual and collective identities, such that the potential to survive creatively is actualized.     

Masks and Faces in the Setting at the Time of Coronavirus

The “health emergency” forced analysts to seek new ways of continuing with analysis. The article focuses, in particular, on the changes brought about in the setting by the presence of the sanitary mask, following a line that begins with the theme of the “mask” in the collective uses of human cultures, and develops through the Jungian concept of persona, as opposed to the “face” that may convey an authentic image of oneself. A clinical vignette illustrates the issues that the mask raises in the setting by obstructing the communication of emotions. When there is no transformative processing of concrete data, “unmasking” can also lead to an uncanny encounter and to moments of darkness and confusion in analysis, when the analyst experiences the kind of “unconscious identity” between therapist and patient that Jung defined as nigredo. The article is intended as a contribution to the analytic community's current reflections on the new and unforeseen challenges encountered in analysis at the time of the Coronavirus. It is possible to learn from these experiences with a view to integrating new elements and thus modify one's own internal setting, the compass with which each analyst orientates himself.     

Emerging as a Personality Disorder Service

Personality Disorder Services working along psychotherapeutic lines are gaining appeal with Health Care Commissioners following the publication of the NICE guidelines for Borderline & Antisocial Personality Disorders and the emerging successful application of psychoanalytically-derived approaches.

Establishing a new Personality Disorder Service is akin to constructing a ‘home’ within which the therapeutic work with patients can develop. As clinicians, we are required to question what facets are important to the development of this new home, and to further to endure the unfamiliar state of being ‘not at home’ while the identity of the service is established.

We address how this process parallels the task facing the patient as they struggle to establish their own identity. We also highlight some important tenets in the work of securing a robust identity for both the service and the patient suffering from a personality disorder.