In this paper the author develops some of the themes discussed in an earlier paper (Ruszczynski, 2006) in which he explored violence in the couple relationship. As in that paper, he is interested in considering whether some of what can be learned from working clinically with especially disturbed forensic and anti-social patients, can be adapted to clinical work with some types of more disturbed couple relationships and with some parts of the relationship of perhaps many couples. The question explored is, if action predominates over reflection—a central characteristic of the types of patients described, that is, those who act out—how do clinicians offer a psychoanalytic experience to such patients for whom the capacity for symbolisation, thought, and reflection is, at best, partial or fragmented?
