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Noting the growing interest in the modified psychoanalytic treatment of schizophrenic patients, Segal feels that this case is of special interest because of her attempt to analyze him 'with only minor deviations from strict analytic technique'.
She then proceeds to a brief summary of the patient's prepsychotic adjustment
and the development of the psychosis during military service. Particular attention is focused on world destruction fantasies, persecutory ideas, loss of ego boundaries, and concretization of thought, especially with reference to symbols.
The treatment process is described from its beginning in an institution, in the patient's home, and finally in the analyst's office under conditions of 'strict analytic technique'.
Segal emphasized her refusal to give the patient reassurance and sympathy, and her insistence on analyzing the transference and resistances. The theoretical formulations and terminology used are those of Melanie Klein. With this orientation it seems likely that 'strict technique' allows latitude for interpretations of delusion, dream, and behavior based largely on manifest content and without the patient's associations.
However, a technical problem of extreme importance is raised by the author—although it is not pursued sufficiently—which is the necessity for the analyst to accept the role of persecutor (to become involved in the patient's delusional system) rather than to strive always to maintain an atmosphere of positive feeling (Federn).
While Segal attributes her therapeutic success to interpretation, it would seem worth while to explore the contribution made by her firm, controlling, and restrictive attitudes toward the patient's anxiety and his departure from the reality principle.
Thus this paper renders an important service by focusing attention on a technical device which is attracting increasing attention in the treatment of psychotic patients: the application, on the basis of structural and economic considerations, of planned