Borderline patients present complex clinical features, with neurotic and psychotic aspects so that literature often define them as ‘difficult’ or ‘at limit’ for pharmacological and psychotherapeutic treatments.

The aim of this study is to introduce the unconscious skills that emerge from dreams of early sessions as an integrative method of evaluation of the possibility for a psychodynamic psychotherapy treatment.

Three patients with previous psychiatric diagnosis of borderline personality disorder with psychotic traits and related drug therapies and/or support psychotherapies, began a psychodynamic psychotherapy with the goal of recovery and resolution of intrapsychic conflicts.

The unconscious reaction to proposition of recovery, instead of only support, was defined by dreams in which the functional, valid and affective structure of patients was prevalent, instead of disturbing and psychopathological aspects.

This unconscious awareness of patients, emerged as a reaction to a valid therapeutic alliance, allowed the continuation of the psychodynamic psychotherapy, that otherwise could be not efficacious or potentially risky as described in literature.

It is possible to start a psychodynamic psychotherapy for ‘difficult’ or ‘at limit’ patients, instead of usually supportive psychotherapies, for the unconscious reaction of a valid therapeutic alliance assessed through dreams of initial psychotherapeutic sessions.

So dreams regain a relevant role in diagnosis and prognosis for these patients, often ignored with decrease of treatment possibilities.