ABSTRACT
Working with severely disturbed borderline adolescents brings confusion, pain, and the sense of being useless, helpless, and alone. This chapter highlights three that seemed crucial in the work with Rachel. Firstly, the issue of emotional containment; second, the terrible distress caused by separation; and third, the difficulties of working with the concrete psychotic thinking that can be common in patients with borderline personalities. The nursing work and the psychotherapy with this patient, Rachel, and while there are many differences in the role of the nurse and therapist and our working relationship with the patient, several common interrelated themes emerge. Important aspects of Rachel's borderline functioning and treatment were her concrete thinking, which at times was psychotic, and her great difficulty with separations. The following clinical material illustrates Rachel's terrible confusion between what was good for her and what was bad, including whether, was good for her or bad.
