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(1977). Psychoanalytic Review, 64:203-210

A Note on the Treatment of the Schizophrenic Patient

Herbert S. Strean, D.S.W.

For over two decades I have been actively engaged in the treatment of and research on the schizophrenic patient. Like most practitioners and practice theorists, I have not only given much thought to the etiology of the schizophrenic process but have constantly modified my therapeutic orientation and therapeutic posture when clinical experience and clinical research have warranted alterations.

Over the years I have come to view psychoanalytic and psychotherapeutic technique as a constantly evolving set of procedures, rooted in theory and influenced by a growing body of clinical experience. Therapists, I believe, develop greater precision, discipline, and finesse in their work as their personal experience expands. As Waldhorn recently stated,

The limitless diversity of our patients' productions, the absolute uniqueness of each individual's life and of each moment in time, make standardization of technique an impossibility and rigidity of style a handicap…. The avoidance of mistaken emphases and of undue preoccupation with any one aspect of analytic material over all others is a vital part of the self-critical, self-observant and selfenriching responsibility of the analyst.8

The enormous literature on schizophrenia so far seems to indicate that no one specific etiological factor can fully account for the process. As Spotnitz has noted, “A biologically inherited disposition for the illness seems to be of some importance, combined with constitutional and experiental factors.”5

When I initially embarked on my work with schizophrenic patients, I was faced almost immediately with a serious therapeutic

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