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Treatment is difficult in schizophrenia because of the patient's withdrawal, inconsiderate and violent behavior, and his free use of symbolism in speech and conduct. The stresses placed on the therapist by these reactions and the consequent activation of the therapist's own conflicts greatly aggravate the difficulties.
The authors feel that limits should be set to the patient's physical acting
out. He should be encouraged to verbalize his aggression. The necessity for seclusion and restraint when needed should be carefully explained to him.
With the mute patient a burden is placed on the therapist's patience. An active therapeutic role is required. The therapist must reach out for all nonverbal clues and base his interpretations on them. It may be necessary to explain to the patient the need for guessing. The therapist understands that the muteness is the patient's defense against expected feelings of bitterness, fear, frustration and rage.
Symbolism is to be interpreted in everyday language. The patient's seeming insight into the character of the therapist should be understood as a projection of the patient's conflicts and not taken seriously by the therapist. The patient's sensitivity to the behavior of others should not be reacted to but treated as a problem of the patient.
Staff discussions of the therapist's difficulties will help to alleviate the engendered frustrations, fears, doubts, and hostilities.