|
APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
This is a psychoanalytic approach that assumes that all the symptoms are meaningful and are related to the life history as subjectively experienced. The unconscious is taken seriously, and everything psychoanalysis has learned about human development and therapy is relevant.
Schizophrenia is a chronic terror syndrome. Patients who develop psychotic symptoms have had lives that would cause profound distress in anyone. It is necessary to create a therapeutic alliance by offering real help with what the patient perceives as the problem. Severely disturbed patients need a warm, strong therapist who will deal with anything. The sicker the patient, the more structure and support the therapist must provide. Conscious insight is helpful, but it is only bearable within a strong, safe relationship. Hallucinations are understood and interpreted like dreams. Delusions are understood primarily as
- transference to the world at large,
- defenses against pseudo-homosexual anxiety (as described by Freud in the Schreber case)
- concepts and meanings idiosyncratic to a particular family, and
- an attempt to make sense out of one's world and life despite strange experiences and symptoms.
The patient uses the therapist for corrective identifications. The therapist is internalized as a less destructive superego, replacing the punitive conscience that is based on the parents. The therapist also provides a model for the ego—how one might be. The relationship with the therapist is internalized as what a human relationship might be like. The patient only keeps internalizations that are useful. As the patient gets healthier, the patient takes a more active role (and the therapist a less active one) in the therapy, and the process becomes like the psychoanalytic therapy of neurotics.
Return to Effective Psychoanalytic Therapy of Schizophrenia and Other Severe Disorders
|
)
