The iconic New York skyline now lacks a famous couple, the twin towers of the World Trade Centre. The devastating attack on a couple is a feature of the internal world of the borderline patient for whom there has often only been an experience of traumatic abusive coupling. Again and again a destructive abusive coupling is enacted in their lives, a compulsion to repeat what cannot be remembered.

Philippe Petit walked between the Twin Towers on a tightrope in 1977; imagine if he had chosen to do so on 11 September 2001. To undertake this walk is to be reckless and yet very respectful of the medium. The risk is unpredictable because no matter how technically skilled, or confident in most aspects of the risk assessment, there are elements which are ultimately beyond the practitioner’s control.

Walking the borderline tightrope evokes questions of life and death, courage and stupidity, sanity and insanity. The halo lifebelt rescue of the patient may be on an angelic wing and a prayer; ill informed other than by an omnipotent blind desire to help. The devil on the other hand cynically offers a pen to sign the death warrant for one’s career in the face of such foolhardy kindness.

The dilemma for the professional is a moral dilemma; they feel torn between their loving capacities to heal and help and their hateful destructiveness which they fear could threaten the constructive impulse. This doubt will lead to a redoubled effort to repair or rescue the patient as the professional attempts to undo or mask their hidden hatred. The psychoanalytic definition of containment in this context is the containment of the professional drive to cure which is a reaction formation against their aggressive and destructive impulses to damage.