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There is a solid tradition in clinical psychiatry representing the application of psychoanalytic insights to the care and treatment of severely disturbed, psychotic patients in the hospital setting. Recent developments in the neurosciences and in clinical psychopharmacology have created a new era in the treatment of such psychotic and near-psychotic conditions that envisions itself as more firmly embedded in scientific methods and as having uprooted and replaced older psychodynamic orientations to the treatment and understanding of these patients. Undoubtedly, the emergence on the clinical horizon of reasonably effective medications for the treatment of a variety of psychotic illnesses has been of immense benefit to afflicted patients. Among the unfortunate results of this paradigmatic shift, however, is that for many patients for whom drug treatment is relatively ineffective, or only partially so, other possible therapeutic resources are unavailable, both because therapists with the requisite skills are increasingly in short supply and because a generation of psychiatric practitioners currently in training have little or no awareness or experience in psychodynamic approaches to these patients.
Fortunately, the psychoanalytic and psychodynamic contribution has not been completely lost and, in fact, has enjoyed something of a revival as clinicians become increasingly aware of the inherent limitations of a unimodal approach to these treatment problems, whether by way of exclusive reliance on drugs or through psychotherapy. More and more, we are becoming aware that effective treatment of the more severely disturbed patient population calls for the integration of treatment resources of many kinds and that the implementation of therapeutic contributions from multiple disciplines is indicated in more than the occasional