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THE APPROACH I AM TAKING in this reflection on Mr. Baker's psychotherapy will be dictated by the terms of the paranoid process. That approach seems warranted, conveniently enough, since Mr. Baker presented with rather clear-cut paranoid symptomatology. I will postpone a discussion of the nature of the
paranoid process for later in this presentation, but suffice it to say at this point that the approach through the paranoid process offers a particular perspective on the patient's psychopathology and provides a basis for a specifiable schema or program for psychotherapeutic intervention.
The most obvious thing about the treatment of Mr. Baker, and perhaps even surprisingly, is that it worked. On the basic principle that you can't knock success, my approach here will not be an attempt to criticize Balint's interventions with his patient, but rather to try to understand what it was about Mr. Baker's difficulties and Dr. Balint's responses to them that brought about the resolution of the patient's symptoms and the apparent dissolution of his difficulties. The question then is "Why did this therapy work?" and "What can it teach us about the psychotherapeutic process?"
My discussion will follow the usual format with three separate parts. The first issue I would like to address is that of diagnosis, since diagnosis is usually an essential prerequisite for formulating a therapeutic plan. In the second section I would like to focus some of the elements of this case in terms of the aspects of the paranoid process so as to provide some basis for the understanding of Mr. Baker's pathology. And in the final section I would like to address some of the therapeutic issues, perhaps to suggest why particular interventions on Balint's part may have been more or less effective, as well as suggesting alternate pos