You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
In today's clinical landscape, the psychodynamic treatment of psychosis is rare and often dismissed as inappropriate. This shift reflects not only institutional trends but also a deeper discomfort among therapists with the unpredictability and intensity of psychosis. As a consequence, when psychosis “abruptly enters the treatment room—and it often does” (Knafo and Selzer, p. xvi)—many clinicians are unprepared to engage meaningfully with the symptoms and instead either focus on pharmaceutical management or refer the patient elsewhere.
Resisting this prevailing trend in the field, Danielle Knafo and Michael Selzer wrote From Breakdown to Breakthrough to “share [their] experiences with those who wish to learn how to conduct psychodynamic psychotherapy with individuals diagnosed with psychosis or who are undergoing a psychotic episode” (p. xvii). The authors are seasoned clinicians with a century of experience between them, and they describe their book as a “training guide” (p. xvii) for mental health professionals who want to have a better understanding of how to work with states of extreme emotional distress.
Knafo and Selzer approach this daunting task with a dedicated and practical mindset. From Breakdown to Breakthrough is composed of the type of clinical writing that never strays far from
the treatment room—nearly every paragraph responds to the specificity of some clinical encounter, turning over and examining the challenging, complicated, and rewarding relationship that a therapist might develop with an individual with psychosis.
The book takes the reader through the lifecycle of an analysis, with early chapters on “Beginnings,” “Establishing a Pre-alliance,” passing through various aspects of treatment, and finishing with chapters on “Endings” and “Supervision.” Along the way, the reader will find a wealth of theoretical detail and technical recommendations. Their clinical thinking is illustrated with numerous case studies, including a sample intake session in