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This paper is concerned with patients who avail themselves of therapy for extended periods; diagnostically fall in the psychosis or borderline spectrum; and manifest schizophrenic or borderline patterns.
Certain issues regarding them will be discussed:
The significance of the person of the therapist as instrument;
Outcomes of the therapeutic test;
The corrective effect of long-term follow-up studies;
The identification of chronic patients who function as chronic analysts of themselves prior to and during therapy.
Because chronic analysts (Kelman, 1970) will spend a long span of, and often much, time with chronic patients, they will assume increasing importance to them. Ellenberger (1970) emphasized the crucial role certain patients have had for the conceptualizations of their therapists; e.g., Janet's Achilles and Freud's Anna O.
Solomon W., age 55, has some of the attributes of an institution. In therapy since age 16, he has seen more than 25 analysts; a number being Fellows of the Academy. Most contacts were for a single and occasionally a second session. About ten of these analysts he may have seen up to six months, five up to a year, one up to two years, one three and me for four years. For statistical purposes: span defines the time from the first visit to the last contact; duration the time continuously in therapy regardless of the number of sessions weekly; and calculated time is based on a three times a week schedule of 36 weeks yearly, totaling 108 sessions. The analytic span