The author discusses the vicissitudes of working analytically with patients who present with monolithic forms of thinking. He describes an approach that emphasizes the importance of the analyst as a real object that has at first to be explored to discover whether or not what is projected corresponds to the analyst's mind. This exploration of the other often confronts the analyst with their own issues surrounding sanity and madness, life and death; it is through this exploration of these real anxieties in the mind of the object that can lead to the beginnings of thinking in severely ill patients.