A Holistic (Horney) Approach to the Schizophrenias: Part III — The Therapeutic Process

ALTHOUGH there is an abundant literature on the psychoanalysis of the schizophrenias, most of it deals with theoretical concepts, which I have discussed in my previous papers (1, 2). Relatively few analysts have actually attempted to treat these conditions, and even fewer have described their techniques and results in detail. For some classical analysts this reluctance is a carry-over from Freud's position that schizophrenics “become inaccessible to the influence of psychoanalysis and cannot be cured by our efforts.”3 Other analysts have been deterred by practical difficulties supposedly inherent in the psychoses themselves. Among these have been the pessimistic notion of an inevitably poor outcome; the presence of unchangeable genetic, constitutional or organic factors; the long time required for treatment; the intense emotional swings or the lack of emotionality; the handling of impulsiveness, acting-out or aggressiveness; the difficulty in making a viable therapeutic relationship; the tremendous, insatiable demands on the analyst; the alleged difficulty in communicating or understanding the patient; and the belief that unconscious content could not be interpreted because of a collapse of defenses.

The present climate of psychiatric practice also seems to be contributing to this reluctance. The community mental health movement has been emphasizing treatment of the greatest number of patients, with rapid and superficial symptomatic improvement involving adjustment or resocialization, rather than the slower and deeper but more permanent personality change. Insted, many potential psychotherapists are focusing on behavior therapy, group or encounter therapy, drug therapy or direct environmental manipulation; and the psychiatrist becomes a social interventionist rather than being concerned with dynamic, intrapsychic phenomena.

In any event, the present consensus among many psychiatrists and psychoanalysts is still that the therapeutic results of analysis and/or analytica