The Treatment of Acute Schizophrenic Patients in Private Practice

There are more schizophrenic patients outside hospitals than in them. Acute schizophrenics are a varied group of patients who very frequently may be best treated in outpatient office practice. They need a therapist who is strong enough to be a protective object and an auxiliary ego and who will deal with the unconscious meaning of the hallucinatory and delusional experiences. Relatives may provide support and housing for patients who would otherwise be hospitalised. Relatives can tolerate a psychotic individual surprisingly well if they see this as a response to an emergency situation which will be necessary for only a month or two at most. The availability of the therapist to the patient by telephone also permits the patient to deal with experiences and situations that would otherwise overwhelm him and require hospitalisation, or end in suicide. How to deal with patients without medication or how optimally to use medication, if that is the therapist's or the patient's preference, is discussed. In the light of current evidence it is clear that prolonged and continuous medication is not neurologically in the patient's best interest.