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JAA 18(1):99-114 (1990)

Infinite Reflections: The Opening Phase of Intensive Psychotherapy with a Chronically Schizophrenic Patient

Authors: Richard M. Waugaman MD, Harold F. Searles MD

Abstract

This paper focuses on a number of transference and countertransference issues in the author's psychotherapy with Allan, which was supervised by Harold Searles. One prominent feature of the work was Allan's extreme identity confusion. Among the many manifestations of his lack of a coherent identity was Allan's habit of referring to himself in the third person, as “he” rather than as “I.” As the psychotherapy unfolded, Allan began to treat me as though I were he, often addressing me as “Allan.” For his part, he consciously identified himself as my therapist. This was a dramatically overt example of what Searles has described as “the patient as therapist to his analyst,” a process that is usually far more subtle and disguised. Allan's psychotic role reversal simultaneously served several purposes—it offered him a seemingly more cohesive identity than his psychotically fragmented self; by projective identification, it informed me on an emotional level of what he was experiencing himself; it offered a commentary on how he perceived my functioning in the role of therapist; and it provided me with
* Supervising and Training Analyst, Washington Psychoanalytic Institute; Associate Clinical Professor of Psychiatry, Georgetown University School of Medicine.
** Supervising and Training Analyst, Washington Psychoanalytic Institute; formerly, Clinical Professor of Psychiatry, Georgetown University School of Medicine.
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a role model of how he wished I would function as his therapist.

This contribution reviews the first six months of the intensive psychotherapy of Allan, a chronically psychotic patient at Chestnut Lodge, which was conducted and supervised by the authors (RMW and HFS, respectively). This work began soon after I* joined the staff of Chestnut Lodge, so the opening phase of treatment coincided with both the patient's and my own first months there. I want to acknowledge here the crucial role played by the other members of Allan's treatment team.

On admission, this patient had bee

JAA 18(1):99-114 (1990)

Infinite Reflections: The Opening Phase of Intensive Psychotherapy with a Chronically Schizophrenic Patient

Authors: Richard M. Waugaman MD, Harold F. Searles MD

Abstract

This paper focuses on a number of transference and countertransference issues in the author's psychotherapy with Allan, which was supervised by Harold Searles. One prominent feature of the work was Allan's extreme identity confusion. Among the many manifestations of his lack of a coherent identity was Allan's habit of referring to himself in the third person, as “he” rather than as “I.” As the psychotherapy unfolded, Allan began to treat me as though I were he, often addressing me as “Allan.” For his part, he consciously identified himself as my therapist. This was a dramatically overt example of what Searles has described as “the patient as therapist to his analyst,” a process that is usually far more subtle and disguised. Allan's psychotic role reversal simultaneously served several purposes—it offered him a seemingly more cohesive identity than his psychotically fragmented self; by projective identification, it informed me on an emotional level of what he was experiencing himself; it offered a commentary on how he perceived my functioning in the role of therapist; and it provided me with
* Supervising and Training Analyst, Washington Psychoanalytic Institute; Associate Clinical Professor of Psychiatry, Georgetown University School of Medicine.
** Supervising and Training Analyst, Washington Psychoanalytic Institute; formerly, Clinical Professor of Psychiatry, Georgetown University School of Medicine.
Page 99
a role model of how he wished I would function as his therapist.

On admission, this patient had bee