The following is a reflection upon the challenges presented to an in-patient nursing team in their care of Sarah. The intention is to illustrate the value of application of psychoanalytic theory to this case in order to increase nurses’ understanding of the internal world of our young patient, thereby improving nursing care, supervision and minimizing potential adverse impact of such a damaged young person upon the quality of care on the unit as a whole. All names have been changed and some background details have been altered or omitted to protect identities.