ABSTRACT
This chapter illustrates the emergence of a psychotic core during the analytical treatment of a young patient with the emergence of delusional ideas. These phenomena made it possible to investigate the relationship of a transgenerational family secret in both the family's functioning and the patient's personal history. A double register of mental and relational functioning runs through both the patient's inner world and the family's phantasmatic life from the outset, permeating the analytic relationship itself.
This double register, based on splitting and denial, is present in the patient's parental couple as well as in the patient himself, thereby generating a contradictory and paradoxical mode of functioning, which in the therapeutic relationship re-proposes a paradoxical dissociation, similar to the one the patient experienced from the origin of life.
The theme is discussed in light of Winnicott's essays and the importance of consonance and reciprocity in the treatment of severe patients.
