Emergency Interventions and Direct Interventions in Psychotic Crises during Psychotherapy1

The term psychotic crisis should be understood not only as an acute psychopathological syndrome occurring in the whole spectrum of psychoses, but also as a crisis that may occur in a healed patient facing difficulties in everyday life, or as a sudden change in a long and monotonous psychotherapy. The therapeutical duty often consists in “teaching” the patient to forget the urgency of the situation, as a condition for a serious work on himself. “Urgent intervention” by the therapist should be differentiated from “direct intervention”. The former requires abandoning of the classical setting of verbal encounter, whereas “direct interventions” even if urgent and different from the usual psychoanalytic interventions, do not imply a change in the setting. I use this method only with psychotic patients in a situation of crisis. It implies “progressive overturnings” i.e. changing the situation of the patient in a positive direction by images arising from our therapeutic unconscious as a “projection” of the therapeutical imago. Usually they are verbal, but here I will show graphic and what I call “transforming” images. The “overturnings” are here summarized as 1. The overturning of autism into a one-to-one relationship 2. the overturning of repression into integration 3. the overturning of the destructive splitting into individuation.