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For the treatment of this patient who is in danger on the psychosomatic (HTA) and perverse levels, the author justifies the choice of the setting of corporal psychoanalytic psy-chotherapy (PPC) through the mediation of the body which can serve as a buttress for speech that cannot sustain itself. The gaze gives solid support to the sense of reality. The defence of sadism is elaborated as a masochistic reversal which, in conjunction with the narcissistic recognition of pain, makes it possible to loosen the grip of excitation over the subject who dif-ferentiates himself.