People seek treatment at the Austen Riggs Center in the context of profound difficulties in adaptation that are marked diagnostically by mood disorders and personality disorders. Although mood and personality disorders have different diagnostic criteria, they cannot entirely be disentangled, each linked to dysfunctional parenting in childhood. Treatments that focus primarily on the depressive symptoms may miss the underlying difficulties with affect regulation linked to character pathology. I will link research and theory to clinical evidence to illustrate ways in which psychoanalytic therapy can be useful in enhancing mentalization in individuals with complex symptom pictures.