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The essential differences in psychoanalytic technique in treating neuroses and psychoses are discussed. Psychoanalysis of the psychoses is different not only in such details as an avoidance of the use of the couch, but also in more important ways. The analyst may, for instance, cease treatment temporarily and be replaced by a sympathetic member of the family guided by the analyst. Nevertheless, the method sponsored by Federn is 'not mere psychotherapy with
psychoanalytical knowledge. It is true psychoanalysis… The application of the economical, topical and dynamic viewpoints while using free association and coping with transference and resistance.' Indeed, throughout the paper one gains the impression that the author consistently adapts the psychoanalytic method to the requirements of the individual patient. His main goal is to restore the functioning of a deeply injured ego, and he never sacrifices the ego of the patient to a therapeutic principle or abandons a rational therapy for the sake of a cheap transference success.
Federn was one of the first to recognize that the transference of the psychotic is the chief problem of the psychoanalysis of psychotics, opposing those who thought that there is 'no transference in psychosis'. However, the transference has a different meaning to the psychotic than to the neurotic and therefore requires different handling. The main difference is that in the psychotic patient the positive transference should never be permitted to change into a negative one. Whereas the neurotic patient is able to continue treatment in spite of phases of negative transference, the psychotic cannot be treated by a physician who has become an object of negative transference. Since temporary or even long-lasting periods of negative transference are unavoidable, the treatment must be supplemented by the coöperation of a helper, preferably a woman who may be a nurse or a member of the family. According to Federn, the dynamism of treatment i