This paper focuses on the specificity of clinical work with patients displaying areas of mental functioning connected to primitive defences and anxieties, areas that, at an early stage, are distorted into psychotic cores that are extremely difficult to identify and transform.

A clinical illustration shows how the analytic work with a patient revealed that neurotic aspects of her functioning were covering other areas where external and emotional reality was escaped from and manipulated through the creation of parallel magic-illusory realities. These realities have the purpose on the one hand to cope defensively with “primitive agonies”, but, on the other hand, were nourishing mental states full of sensory pleasure. Living in the other refers to the subjective dimension of a capturing withdrawal into omnipotent fantasies and self-deceptive identifications. This delusional dis-functioning, even if accurately analysed during the first years of analysis, was paradoxically transformed only through a “fact of reality” that disturbed the usual setting: the irruption of the objective real experience of an illness of the analyst and, thus, the cancellation of the sessions for a few weeks. That turbulent moment broke the subjective-dissociated dimension where the patient was still “living”, opening up the door to a more authentic relationship with reality.

The clinical illustration is enriched by a theoretical discussion of the many authors whose contributions are useful to reflect on the different implications — also technical — of this complex psychopathological phenomenology.