ABSTRACT
There has been much discussion in recent decades about the relative importance, with borderline or very damaged patients, of two different levels of work: that is, of insight versus other, more primary, levels of understanding. In this chapter, I shall show that I agree with these authors, but will also suggest the need for a third level which is prior to both. I am also offering the idea that all three may be linked as points on a continuum of levels of meaning. At the third level (of psychopathology and, therefore, of technique) the question arises of whether feelings and meanings matter at all to patients in affectless states of autism, dissociation, despairing apathy or deviant states of excitement.
