Introduction

Psychoanalytic literature offers plenty on theory and technique, but little on the detail of mutual clinical exchanges in the consulting room. Today, psychoanalysis has become very much a part of the cultural fibre of the times and lay people, having an awareness of its potential, are more demanding in their expectations of psychotherapy, if deciding to enter treatment. Psychoanalytic therapy could be said to be predicated on separation anxiety and loss. Some problems appear insurmountable in the psychotherapeutic process but with current developments in theoretical and technical understanding, clinical boundaries have expanded and analytic work can proceed with particularly difficult patients. Diane Lefevre emphasises the dangers of missing possible psychotic aspects of a patient. She stresses the importance of careful assessment diagnosis, particularly with regard to differentiating between the psychotic and nonpsychotic aspects of the patient. She describes how the therapist can use psychoanalytic concepts as part of long term treatment in a hospital setting.