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The Editors
In this detailed and informative case study, Endre Koritar illustrates the effective use of psychoanalytic methods in an unusual and unpredictable clinical situation: the evolution of his work with the delusional, paranoid patient Dave, whom he first met on an inpatient ward.
Noting his ego strength, insight into the psychosis, and desire to work dynamically, I offered [the patient] analysis after his recovery. We agreed to stop his antipsychotic medication and mood stabilizer medications early in the analysis as he was developing tardive dyskinesia.
Koritar situates his work with Dave in the tradition of Sándor Ferenczi, emphasizing Ferenczi's view that, with very disturbed patients, “the analyst has to be able to share and bare the patient's terror and suffering.” From Ferenczi he also draws the recommendation of a “relaxation of standard technique. Being honest, admitting one's mistakes, being sincere and genuine … helps patients integrate splits and fragmentation in their personalities.”
Koritar compares the analyst's capacity “to conceive the patient's experiential state symbolically” to Winnicott's concept of primary maternal preoccupation.
He goes on to say he felt “that it would be the process of analysis, not the analysis of the content of [Dave's] mind, that would affect internal transformation and solidify his internal structure.” This emphasis on process rather than content is compatible with most contemporary perspectives