The difficulty for staff working with forensic and psychotic patients is that they are working with patients who confront them with their own worst anxieties. The author describes his experience of applying a psychoanalytic perspective to such patients, seen in both institutional settings and in his private practice, and how such an approach might begin to translate patients' concrete enactment to often painful and terrifying thinking. The experience of consultancy to the homeless hostel and the analysis of the patient who aborts her foetus are similar. The main communication by both is at first evacuative, an attempt to gain mastery over unbearable experiences by placing them in the minds and bodies of others. The patient, however, is able to assist the analyst by dreaming, bringing their own unconscious meaning to bear on the work. Sexualization and violence become a mental state that is used to withdraw from reality and the need to relate to the world.