Unconscious Repetition of a Patient’s Dynamics on an Inpatient Unit: Treatment Challenges

This article focuses on the unconscious repetition of a patient’s dynamics among a multidisciplinary inpatient treatment team. The patient was diagnosed as having bipolar affective illness and borderline personality traits. The prominent borderline traits displayed by the patient during hypomanic episodes evoked a parallel process of the patient’s internal conflicts, rendering the team temporarily divided regarding treatment plans. This divide was resolved by holding dedicated multidisciplinary team meetings in which the patient’s projections onto the team were explained and understood. The article highlights some of the therapeutic complexities of and challenges in treating a patient with bipolar illness and borderline traits on an inpatient unit.