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Nowadays analysts agree that an important part of their patients are not neurotic, contrary to the times when Freud had founded psychoanalysis. Freud had discovered psychoanalysis in his work with hysterical patients and he had always sustained that psychotic patients could not be taken to analysis. But since 1950 psychosis has entered the analytical field and has transformed the psychoanalytical theory. Most of the patients who address themselves to the analyst tend to suffer from narcissistic or psychosomatic disorders. Narcissistic patients have a psychotic or perverse structure. During the preliminary interviews the analyst has to evaluate the psychic functioning of the patient and thus decide if psychoanalysis is possible. This decision depends on the possibility of the patient to benefit from the psychoanalytical method and setting. Can the patient on the couch work without seeing the analyst and bear the silence or the analyst's interpretation of the resistance and transference? The question of separation or frustration related to satisfaction can it is tolerable? A psychotherapy can be decided in cases where predominate difficulties of symbolization due to early childhood traumas or in masochistic structures of the ego with self-destructive drives.