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A psychoanalytically oriented treatment of a middle-aged male schizophrenic patient is described. The therapy lasted for ten years, with a follow-up period of four years. The frequency of sessions was once a week throughout.
The patient had been chronically psychotic for five years hearing voices accusing him of masturbation. From the beginning a positive transference with idealization developed. Mutual trust and a sense of communion was an important feature of the therapeutic relationship. Humour played an important part even during the most difficult periods of the patient's psychosis. He came regularly to sessions and was able to finish his studies soon after starting in therapy.
The psychosis continued for many years. The pivotal point occurred after six year's of therapy when the patient dared to travel abroad alone and realised that the voices, speaking to him in Finnish, must be hallucinations, as he was surrounded by foreigners who did not know his native language.
The economic recession forced the patient to stop therapy. During the follow-up period the frequency of sessions has been four times a year. The patient's physical and psychical health have improved and no more psychotic spells have occurred. He now owns an engineering firm, which is doing well.