Organizations attempting to care and deliver services for those suffering from severe personality disorders and who may have violated society’s norms in a violent or serious criminal manner have the enormous task of managing the conflicting attitudes about such people that exist within the wider society. These attitudes, whose nature is based on the desire for punishment, keeping society safe, and treatment and care, are reflected in the imperatives of those commissioning services, as well as present in the staff working in the organizations. The challenge to organizations is to manage the complex feelings and thoughts of both the external (within society) and internal environment (members of the staff) to maintain coherence and avoid chaos. Leaders of these organizations need to transform the conflicting motivations into a framework for developing a coherent purpose and strategy, and organizational culture. One way to achieve this transformation is to replace punishment and safety with containment and treatment and care with psychosocial therapy and rehabilitation. This reconstruction may help deal with the expectations from the external environment and allow the leaders of the service organizations to create a culture, purpose, and strategy that is both coherent and well understood, as well as allow those suffering from a serious personality disorder to have a chance of developing more satisfying lives. References