Meetings of the New York Psychoanalytic Society

June 13, 1950. THE OPTIMUM CONDITIONS FOR THE TREATMENT OF SCHIZOPHRENIC PSYCHOSIS BY DIRECT ANALYTIC THERAPY. John N. Rosen, M.D.

The optimum conditions for successful treatment of schizophrenic psychosis by direct analysis are 1, the application of treatment during the phase of relatively coherent verbalization; 2, treatment before further spontaneous regression ensues; 3, treatment before further regression results from incarceration or mistreatment.

These conclusions are based on the treatment during the past six years of schizophrenics who had proved resistant to the usual forms of 'organic therapy'. Twenty-seven of these rapidly responded to direct analysis. The conventional diagnostic categories indicate little about the prognosis. The differences in speed of recovery are related primarily to differences in the level of regression prevailing at the beginning of treatment. The most important aspect of repression from the standpoint of treatment by direct analysis is verbalization, since direct analysis puts major reliance on intelligible verbal exposure of the unconscious. It is therefore important to begin treatment while the patient can still speak intelligibly.

Direct analysis is also indicated at the earliest moment at which it is presumed that, without the intervention of therapy, there will be further regression. Little is known about spontaneous remissions, but it is assumed that it is unlikely that there will be arrest of the disorder or recovery without treatment. The third optimum condition for the use of direct analysis is its application before other methods have failed. By furthering regression, alternative treatment by hospitalization or shock interferes with therapy. Direct analysis applied under these optimal conditions will resolve a psychosis in a matter of weeks or months, rather than years. Classical freudian analysis following the resolution of the psychosis results in 'immunization', i.e., leaves the patient better equipped to fa