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In this paper some difficulties in the management of borderline patients being treated on two specialist inpatient units will be explored in the light of changes in the health-care system. On these units, nursing staff developed beliefs about care, based on previous experience of difficulties in the clinical area. In many ways, these assumptions about the patient group were based on common-sense. However, when prescribed indiscriminantly, they became ‘over-valued’ ideas, which acted as a defence against the patients’ communications. Nurses stopped thinking about the meaning of the patients’ behaviour, and based their actions and behaviour on pre-selected understanding connected with their own defensive needs. The process of introjection and projection necessary for containment was short-circuited, and nurses acted as if they knew what the patients’ behaviour meant, rather than wait for meaning to emerge. Despite the patients’ denial of their pathology, when they feel their carers have lost touch with the level of their psychological difficulties, they act out in ways which force the nursing-team into action. When the nursing-team reacts without thinking about the meaning of the patients’ behaviour, a mindless and often destructive cycle of action and reaction takes place between staff and patients. This cycle goes against the philosophy of both units, which is to help patients to verbalise rather than act-out their difficulties.