The experience of being reminded, is shown in The Psychic Warrior as a process of personal working though in the mind of the professional to help the patient, which can be contrasted with the experience in Borderline Professional Disorder of a professional who is being disturbed in such a way they cannot work this experience through in isolation with the patient. In the fragmented situation of being disturbed, quotidian in acute psychiatric work, it is vital that colleagues collaborate to reflect together to share the process of being disturbed in the interest of working towards integration of splitting at an interpersonal level between professionals on behalf of the patient.

The two counter-transference cartoon series contrast psychic conflict and psychic collision as a metaphor for the difference between everyday psychoanalytic practice in the consulting room and the application of psychoanalytic thinking outside the consulting room.

The Psychic Warrior shows a working through of conflict in the counter­transference with a patient who is depressed and suicidal which can be achieved in psychotherapy on a one to one basis.

If one thinks of the dynamic of feelings as the dynamic of physical movement, this type of pedestrian counter-transference, rather like bumping into someone on the street, the walking pace of mental pain, which can be processed.

Borderline Professional Disorder shows a level of disturbance borne from an unconscious demand to get into the mind of the other which can be experienced by the professional as a collision, a disturbing communication by unconscious impact.

I think of this experience of being disturbed as more primitive than being reminded, and because it's more unconscious it cannot be processed or understood so readily. I see this collision by unconscious impact as a car crash counter-transference.

Reflective practice in offering a space to think about enactment between patient and professionals requires professionals working through their counter­transference together, with a third perspective from colleagues in reflection, to become aware of the echo of past repetition in the present, being aware meaning to become conscious of the professional’s part of the problem in a ‘do away with damage or be damned’ mentality which, if it can be acknowledged, may be mourned.

As a doctor who once worked in Casualty department, the distinction between levels of psychic disturbance in people and their impact on the professionals who try to help them can be seen as the psychological equivalent of the physical differentiation in physical morbidity and mortality in triage.

Triage is the distinction between the walking wounded, not in need of immediate help, the very ill, in need of urgent help and those who are already dead. Where disturbance is more accessible, closer to consciousness than coma, a sensation and feeling can be reflected on and responded to rather than reacted against. This ‘walking wounded’ state is a pedestrian counter-transference, but still may not be become conscious or understood and still lead to patient and professional enactment.

Deeper disturbance in the patient, like being physically unconscious, a psychic coma, is linked with early unconscious and pre-verbal experience that is felt and reacted to rather than thought and reflected on. This is the car crash counter­transference, not so much a communication as a collision.

Waiting in the face of powerful conscious and unconscious demands for urgent care in high risk car crash counter-transference scenarios make the option of delay and pause for thought seem negligent; only action is enough.

The physical triage metaphor becomes most problematic in knowing when psychic damage cannot be repaired, even if understood. In the mental health arena the medical concept of palliative care has a limited place; it can be seen in remaining involved and offering care despite knowing the limits rather than throwing the towel in and giving up on care.