On Questioning the Psychotherapy of Psychosis: Discussion of “Care and Confidence,” by Päivikki Viinisalo

Some clinical case presentations provide detailed inside accounts of major events, usually more revealing of, and occasionally reveling in, the bright interpretations of the therapist. Others are more theoretical, less descriptive, and reflecting on the lessons of the great names of our profession. And then there are those that in an amiable and sensible way shift through memories of a difficult encounter in a more existential dimension. Here the presenter tries to recount what happened in between subjectivities in a description of moments of miscommunication and failure and moments of successful understanding. Dr. Viinisalo's presentation is closer to this third kind and tells us more truly what the psychotherapy of psychosis can possibly be in this “impossible profession” of ours.

The richness of this case presentation brings us to a confrontation with the problem of the psychotherapy of psychosis, and to how we can refer, in psychoanalysis, to the so-called narcissistic neurosis, without denying any of the questions it brings to a practice that is, essentially, an interpretative practice. The problem of the specificity of the psychosis appears in the interpretative dimension of psychoanalysis, when we recognize that the difference established by Freud, around the concept of transference, between the transference neurosis and the narcissistic neurosis, starts from the presupposition of an absence of “otherness sensibility” in the psychosis, a failure of symbolization and of access to the “order” of the symbolic.

This clinical case presentation starts with a reference to “care” and