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Many psychiatrists and psychotherapists who work intensively with psychotic children wonder about the effectiveness of their efforts. It is true that changes occur which may be observed by the environment as well as by administering psychological tests. Most workers, however, feel that even in those cases where a favorable change can be noted, the diagnosis remains unchanged. Frequently such changes are not sufficient to enable psychotics to function adequately in society, either during childhood or in later years. It is therefore a refreshing surprise to find an author who sees not only a change in functioning of his patients but also a change in diagnosis. Des Lauriers explains here a definite and concise treatment program by which he achieves this.
Each therapist has his own individual approach, doubtless based on his theoretical convictions. In working with a psychotic, the person of the therapist enters more into the treatment picture than in work with a neurotic, whether the therapist be an analyst, a psychologist, or a social worker. In working with children, this is true to an even greater extent.
Out of the total complex symptomatology of the schizophrenic patient, Des Lauriers places the relationship to reality in the center of his approach. He has read an impressive amount of literature on the subject, especially by psychoanalysts. He finds specific support for his thesis in the work of Paul Federn, particularly in Federn's thoughts on ego boundaries. In a book of two hundred fifteen pages, the bibliography requires thirteen pages. However, the author uses the literature solely to substantiate his view on reality testing.
Des Lauriers quotes Freud's view that in psychosis the conflict is between ego and outside world. Although this is so in classic psychosis, the pathogenesis of the psychoses, also according to Freud, is much more complex. Moreover, since Freud wrote this, the concept of psychosis has undergone many changes and still is