Aloneness in tenuous self-states.

This article describes the inner world of severely impaired clients who operate within a behavioral mode of violence and manipulation. Clients who employ such tactics are attempting to exert control over an internal environment that threatens their sense of self-cohesion. While descriptive labels of "uncooperative" and "manipulative" may be apt, these terms are used pejoratively all too often. This article outlines nursing approaches that assist these clients to achieve greater self-cohesion.