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The patients who have accompanied me over the years, including a certain stable proportion of psychotic patients, have pushed me to modify the points of view I acquired during my training, and have led me to think that the usual focus on the external relationship can be toxic for many of our patients. I will start with a caveat to introduce the primacy of the patient and the body-mind relationship, considering briefly some multilayered aspects. There are patients who, at different times in their history, have undergone intrusive or otherwise deeply damaging experiences to their identity (Williams, 2010). For these patients, the corrective role of a new relationship has always been emphasized; more specifically, I believe it is necessary to foreground the subject in relation to the self, through a strategic use of the relationship. This emphasis was underlined by Bion (1988) in his later years:
The oracle of Delphi was supposed to have carved into the stone, “Know thyself.” So the idea that it is useful and helpful to “know thyself” is not new. In that sense we are trying to say, “I will help you to know yourself. If you tell me something, I will tell it back again to you in a way in which you may be able to see yourself.” I am trying to be a mirror which doesn't tell you who I am — that is of no importance whatsoever — but who you are. (p. 239)
Most recently in clinical practice, more and more often, we encounter patients who claim they do not exist, feeling lost in the infinite and the shapeless (Lombardi, 2015, 2016). The patient's body and the unfolding of bodily sensations and feelings then become a fundamental resource, a compass to guide elaboration — even more so than the external relationship, which risks reintroducing the danger of a loss of personal boundaries.
Moreover, our current patients often show great intellectual and symbolic capacities, yet struggle on the most elementary levels of mental
functioning; these levels may remain hidden if not addressed