Discussion

This symposium has moved from the individual to the family, from the inside out to the outside in. Dr. Franklin sets out a proposition that rigorously defines the life-and-death issues in schizophrenia, and the reviving efforts of the therapist expertly presented in the case study of our now old friend from the planet Zena, who had to make the choice of suicide or psychosis.

Dr. Franklin said it is the use of the therapeutic self to energize the constructiveness of the family that is crucial in family therapy. Many times in individual therapy, when our patients tell us what they were up against in their childhood, we have wondered whether it had really been that bad. Family therapy gives us the answer—it was usually worse. The very structure of family therapy—seeing the family in action together and seeing the patient able to survive and continue to struggle in the pathological milieu—reaffirms my belief in the patient's constructiveness.

Since much of the dynamics of Susan's case has been discussed previously in our clinic and in a chapter in the book, Intensive Family Therapy,¹ I would like to present some new ideas about how the therapist used himself and his activity in providing leadership for the family. Dr. Franklin began by developing his relationship with Susan, and apparently sufficiently assured her that he would protect her in the joint sessions from the family destructiveness. It was also my impression that as she moved towards the doctor in establishing the medical school on Zena, and when she was kissed by the lifeguard (the guardian of her life), she was moving into a life-and-death relationship with Dr. Franklin. In order for the schizophrenic patient to relate effectively to the therapist, she must see him in this light—as her lifesaver. Dr. Franklin paid careful attention to the possibility of this girl's acting out, especially with her hands when she became sexually excited. He said to her, “Put the hammer down.” Another sexual phenomenon connected