Five-Year Results of Psychoanalytic Therapy and Day Care for Acute Schizophrenic Patients

From January 1969 through December 1973, the Karen Horney Clinic conducted a comprehensive psychoanalytic and day-care treatment program for acute schizophrenic patients. The objectives of this program and Center were: (1) to furnish an intermediate transitional-care facility for patients discharged from a psychiatric hospital and no longer requiring full-time hospitalization, yet still too disturbed to function in their habitual work, school, and home environments or social activities and relationships; (2) to provide short-term improvement of the acute psychotic symptoms and behavioral dysfunctions and to bring about social and vocational rehabilitation; (3) to produce over the long term, an arrest of the psychotic process, constructive personality change, lessening of the possibilities of recurrence, and a higher baseline level of functioning closer to the patient's optimal potentials; (4) to evaluate the effectiveness in schizophrenia of modified analytic psychotherapy of unlimited duration, based on the Horney theories, that is, culture-based, conflict resolving, and growth oriented. Since these objectives involved both short- and long-term changes, a five-year period was considered sufficient to at least provide preliminary results, if not to give definitive answers.

The need for each of these objectives is still acute today, in view of the shortcomings of our present methods of treatment and disposition of the young acute schizophrenic patient. Since these problems have already been spelled out in a previous paper,’ they will merely be noted briefly here. The current policy of rapid discharge from psychiatric facilities, with emphasis on gross social “adjustment” and control of manifest psychotic symptoms, leaves many patients inadequately prepared to function in their previous family or social milieus. Protected living arrangements or specific vocational rehabilitation facilities other than the standard after-care clinic are often required and not available.