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Inspired by his work with deeply disturbed chronically psychotic patients, the author demonstrates a double repetition: that of patients and of their caregivers (repetition in care, its rules and rituals, sustained by a certain “psychoanalysm”). From a specific clinical situation, the author shows how these two repetitions are characterized by the fact that they act out and respond in a transferential mode (as well as counter-transferential) specific to serious psychosis: a “transference resistance” that makes more of a substitution than a transference. Repetition in care thus seems like the main way to counter what is most deadly in these patients’ everyday life, by erotizing it and risking a sadomasochistic relationship.