ABSTRACT
This chapter shows that exploration of the dreams of certain psychotic patients might prove useful for understanding their psychosis and contribute to the analytic work of modifying the delusional state. One of the complex and paradoxical aspects of the analytic therapy of psychotic patients is that the psychotic functioning is invisible in the clinical material, and that, when it emerges, it does so suddenly and unexpectedly, after the transformation into “psychosis” has taken place. A convincing example is that of a sadomasochistic patient who had succeeded in giving up perverse fantasying in the waking state, but who for a while used night dreams to enter the perverse dimension that was closed off while he was awake. Dreams, for this patient, constituted not “dreaming” but a form of “acting out”. The chapter concludes by recalling the statement made at the beginning concerning the difficulty of using the associative method where the dreamer’s mental state is approaching that of psychosis.
