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A number of important developments in the psychotherapy of schizophrenia had their origins in the 1930s. In England, Melanie Klein (1930, 1946), Edward Glover and their colleagues attempted to establish with greater precision the supposed fixation points at which psychotic patients seemed developmentally arrested. As a result of direct analytic work with children (Freud, it will be remembered, analyzed “Little Hans” vicariously through the father), Klein felt that infants passed through distinct phases (“paranoid/schizoid,” depressive”) whose clinical features bore strong resemblance to the classical manic-depressive and schizophrenic psychoses encountered among mentally ill adults. The defense mechanisms (denial, projection, splitting) seemed similar also. This led Glover to opine that “… we are all larval psychotics and have been so since age two” (1932). The new metapsychological framework for understanding psychotic patients was to lead, it was hoped by the Kleinians, to improved techniques for reaching them psychotherapeutically. Melanie Klein did not herself work with adult psychotic patients, but a number of prominent analysts who were strongly influenced by her work did: Wilfred Bion (1967), Herbert Rosenfeld (1966) and Hanna Segal (1950).
On our side of the Atlantic, Harry Stack Sullivan was to begin his epochal studies in schizophrenia, out of which an “interpersonal approach” was to evolve. This approach stressed the need for a professionally distant yet involved and compassionate therapist who was capable of recognizing his own minute-to-minute emotions as these were engendered by the primitive affects and defenses