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It is of interest to have Hoedemaker's working concepts and techniques in treating schizophrenics in juxtaposition with the Chestnut Lodge research project papers above. Their ideas are not necessarily mutually exclusive; no doubt the Chestnut Lodge group work toward creating healthy identifications in the patient, and Hoedemaker works toward understanding processes of dependency. But by implication the techniques sound different. Apparently Hoedemaker is active, often making decisions for the patient. The Chestnut Lodge group emphasize understanding, though this comes about by interaction with the analyst as a real person.
Hoedemaker believes that the schizophrenic is ill chiefly because of the presence of overwhelmingly pathological identifications from the earliest years which cause paralysis of such ego functions as reality testing, and bring about regression to oral levels of functioning. He works toward creating new identifications leading to a new superegolike structure. He discusses one patient in detail, showing how she created a situation many times that caused the therapist to react aggressively toward her, incorporated this aggressive act, and then showed ability to handle a similar situation in the real world. This patient's mother responded to any interest the patient expressed in anything by ignoring it, killing her off in effect. The patient's archaic superego could not contain its aggression and 'killed off' the ego in the same fashion. The patient's ego was hungry to observe and incorporate some other person's way of meeting as many divergent situations as possible.