(Accepted for publication 1 May 2014)

The author states that psychoanalysis has much to contribute to schizophrenia. Beginning with a development of Freudian metapsychology, he addresses the in-depth psychopathological study of a session (the first on the couch) with a schizophrenic patient who hears voices and feels that he is being watched. Since the symptoms appear at the level of the heard word and the visual image - key to Freudian metapsychology - he delineates a circuit for the word and one for the image, describing a blockage in both and the consequences of these. Furthermore, with regard to the patient's progress, he demonstrates first a quantitative improvement in symptoms, and later qualitative changes in his functioning. He shows how, over a time, functioning is improved in a once-a-week on-the-couch setting after two years of face-to-face treatment.