Contact at the borderline: psychoanalytic psychotherapy with EB patients.

Against expectation, the experience of setting up a psychotherapy service for adult epidermolysis bullosa (EB) patients at St Thomas' Hospital in London has been that take up is slow and wary. Prior indications from the wider team were that need is high. This may reflect differences in the experience of need on the part of patients and staff. Published research on the psychosocial aspects ofEB is minimal. This article proposes a type of genetic trauma particular to this patient group. It then examines some clinical psychodynamics with regard to the capacity of some severely affected patients to experience and acknowledge feelings such as love and need. Some aspects of the psychological significance of the skin as an organ of the body will be discussed, with particular reference to what happens when it goes wrong.