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'Mediate psychotherapy' is presented as a small but useful addition to the psychotherapeutic armamentarium. When the patient is completely uncoöperative,
though otherwise accessible, another member of the family in whom the patient has confidence, usually the marital partner, is chosen as the medium through whom the psychotherapy is done. It consists in obtaining as much material as possible from the patient by means of successive questionnaires. The partner is trained both to obtain and appreciate the meaning of this information. For illustration the case of a thirty-four-year-old man is cited who was treated through his wife while he suffered from an acute homosexual panic and depression.
The patient fought his conflicts with projections and paranoid delusions. He had a strong biparental fixation to an overexacting father and a querulous mother which left in him a conflict of suppressed resentment with extreme emotional dependence upon both parents. Divided affection and loyalty between mother and wife with concomitant impotence on the one hand, and feminine identification and homosexuality with severe superego reactions on the other hand, resulted in two parallel conflicts on both sides of his sexuality leading to the psychosis.
According to Karpman, an otherwise dominating wife, lending herself to mediate psychotherapy, made an understanding and loving mother (probably also father) who solved the patient's Oedipus conflict without guilt.
The technique of mediate psychotherapy was employed by Freud in the case of Little Hans. In Karpman's use of it, however, it is more intimately conditioned by the structure and the circumstances of the case.