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IT IS A WIDELY ACCEPTED BELIEF that a specific and carefully evolved technique is indispensible to therapeutic practice with those patients deemed amenable to psychotherapy. There are, nevertheless, those patients who defy our technique and our method. Among the variety of patients who do not appear to be amenable to the existing evolved technique, who do not "fit in" to the therapeutic setting or framework, are those who seem unable to communicate or enter into a dialogue with the therapist. In these cases, it is difficult for the verbal-symbolic method to get off the ground, because of a basic incongruity between the therapist's framework (which we assume to be essentially verbal-symbolic in character) and the patient's framework (which may, for example, be founded upon perverse, somatic, narcissistic or hallucinatory modes of containment and meaning-creation).
In addressing the challenge of the patient who does not "fit" the basic psychoanalytic situation, I will draw particular attention to