A postgraduate mental health nursing student refers to an incident in practice to reflect on psychiatric diagnosis and the diagnosis of personality disorder. She also discusses the care programme approach as a forum for person-centred practice and shared decision making in mental health care. Mental health practitioners need to pay more attention to their own motivations and behaviour, and listen more intently to the person they are working with. Using the open dialogue model of practice, which relies on transparency between staff, service users and significant others, could improve communication with people diagnosed with a personality disorder.