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During the course of treatment in a chronic schizophrenic, Wexler found it therapeutically efficacious at times to agree with the patient's moral scruples and join in with her severe feelings of self-condemnation. With this as a starting point, Wexler explores some of the theoretical problems involved in the treatment of schizophrenics. He draws some tentative conclusions from his observations: 1. Classical psychoanalytic methods are inapplicable. 2. We need to resurrect a reasonable ego. 3. Between the therapist and the ego lies a chaotic battleground. 4. The structural aspect of the problem must be understood, particularly the relationship of the superego function to reality testing. 5. Sometimes it is the archaic superego of the patient which lies closest to the surface and therefore would be approached first.
Wexler then goes on to describe some of the clinical reports of the work of others in this field which seem to confirm his own clinical experience. He then explores the idea that the therapist may have to play the role of the patient's alter-superego in order to help produce a reasonable ego. This seems to be in keeping with some aspects of Rosen's work as well as with Rado's formulation of the parasitic double of the superego observable in hypnosis. Bender's work with schizophrenic children also seems to confirm this hypothesis.