In this paper the author describes in some detail her work in the art-therapy department of Hill End Hospital. She used not only her understanding of the work of psychoanalytical writers on schizophrenia, particularly Bion and Searles, but, more importantly, her own experience of the patients at the Hospital, to gain an insight into how these very regressed patients think of themselves and their relationship to reality. She illustrates how she used objects and images created by patients from the art materials supplied, during (usually) five two-hour sessions a week, together with conversations (and notes made in the patients’ presence of these conversations) about these images at structured weekly individual-therapy sessions, to help patients to develop from a state of meaninglessness to a position in which they can choose to engage in continuing therapy.