‘This is the pain I feel!’ Projection and emotional pain in the nurse–patient relationship with people diagnosed with personality disorders in forensic and specialist personality disorder services: findings from a mixed methods study

Abstract

This paper reports the lived experience of the nurse–patient relationship in specialist forensic and therapeutic community (TC) settings for people diagnosed with personality disorders (PDs), from the perspectives of both nurses and patients. A sequential mixed methods study incorporating quantitative Delphi study data with qualitative insights based in the tradition of phenomenology and underpinned by a psychoanalytic paradigm. Purposive samples of nurses and patients currently involved in providing or receiving the nurse–patient relationship in TC or forensic mental health settings were included. Qualitative data analysis resulted in three main themes identified by nurses and patients regarding their experiences of the nurse–patient relationship. They were: (1) Pain: processing or passing on? (2) System of social defences. (3) What helps? This paper focuses on the first ‘pain: processing or passing on’ of the three themes. This theme describes highly painful emotional phenomena arising primarily from patients' traumatic antecedents, suffusing interpersonal transactions, including the nurse – patient relationship. This is reported as experienced by nurse and patient participants. The findings emphasise the relevance of integrating Bion's theory of psychological containment and Bowlby's attachment theory into the nurse–patient relationship in services for people diagnosed with PDs.

Keywords:

• nurse–patient relationship
• personality disorder
• attachment theory
• containment
• forensic
• therapeutic community
• projection
• mixed methods

Acknowledgements

Acknowledgements are made to all those who agreed to take part in this study, and to the managers of the research settings who allowed access. Grateful thanks to Vicky Franks, Janet Holmshaw and FeryGazy for their encouragement, advice and assistance at different stages of the research and to Gillian Kelly who co-facilitated the focus groups.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

Paper presented at the Trygve Haavelmo Centennial Symposium, 13 December 2011, in ‘Gamle Festsal’, Domus Academica, Oslo.