Pliable Media as Transitional Space: From Psychotic Indifferentiation toward the Construction of Meaning in Schizophrenia

Clinical material from the treatment of a highly destructive schizophrenic patient is used to demonstrate the role and function of therapeutic mediations in promoting transformation and symbolization. Use of the Squiggle Game as a therapeutic mediation is shown to sustain the therapeutic process and to facilitate working through of the obscure and complex dynamics commonly seen in the treatment of psychotic patients. The Squiggle Game presents a first transitional space entailing both the concreteness of psychosis and the potential for symbolization provided by psychoanalysis. The game becomes the first meeting ground for the progressive encounters of the therapeutic couple, primarily because in it the violent destructiveness of psychosis is partly deflected in a way that fosters development of the transference relationship. Step-by-step emotional transformations gained through the Squiggle Game are reported and discussed, together with the patient's need to rely on nonverbal communicative modes to bring early traumatic experiences that never reached verbalization into treatment. This working through process furthered development of the dyad's intense transference-countertransference dynamics, which stimulated construction of a link between here-and-now and there-and-then in sessions, leading to the patient's integration and a sense of the life-historical significance of her experience.