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How is it possible to deal with the problem of coercion and freedom within the range of psychotherapy with schizophrenics? In this paper I will propose and discuss three points.
The schizophrenic patient, at least initially, often experiences psychotherapy as a kind of coercion imposed upon him, as he does so many other things that are proposed to him by society. This is true not only in those cases where the patient develops aggressive or asocial attitudes which provoke, on the side of the therapist, some defensive measures that are felt in turn to be coercive by the patient. Apart from these surely not infrequent situations, it should be stated that the very fact of psychotherapy in itself, and even our attempt at accepting the patient unconditionally, may be felt by him as some kind of coercion.
“You are transforming me,” says the patient. By this he means simply that he does not experience our interpretations as points of view that he has to think over in order to accept or to reject them. Instead they influence him even psychically, they change his ego, his brain, his face. His psychotic ego is so poorly organized that it cannot stand the impact of the world, not even the mild pressure of a therapeutic world, without getting the ominous feeling of being moulded, channeled, and disorganized. A defensive measure of the sick ego against the feeling of being reduced to lifeless matter is the transformation of every social influence, even that coming from the therapist, into some kind of hallucinating physical matter that is acting upon him. This is specifically true in the face of interpretations that aim at conveying to the patient some kind of intellectual psychodynamic knowledge concerning his symptoms, without letting him know how deeply we may feel identified with him and with his suffering. He cannot change his psychotic experiences; notwithstanding the meanings we attach to them, interpretations from the outside, which the schizophrenic in his disorganized min