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The psychoanalytic psychotherapy of schizophrenic patients has fallen on hard times in recent years. The growing hegemony of the biological model has led to the virtual abandonment of this disease by dynamically oriented therapists. Although some pay lip service to the “biopsychosocial” model of schizophrenia, few therapists devote serious attention to the immensely challenging task of understanding the psychological dimensions of this illness, and using this understanding therapeutically. So it is a pleasant surprise to come across this new book.
Lotterman's target audience might be mental health trainees who are beginning to treat schizophrenic patients and who seek a relatively brief book outlining some dynamic features of the illness, with some guidelines about conducting the psychotherapy of these patients. This book should help such trainees manage their expectable anxiety about facing a schizophrenic patient in ongoing psychotherapy. Lotterman writes clearly, as one who has been deeply immersed in the clinical work he describes. He states that his book is based on 15 years of work with some 20 schizophrenic patients. His orientation is primarily clinical, but it is informed by a solid grasp of relevant theory, and he makes some theoretical contributions of his own (e.g., “deconceptualization” as a mechanism of defense). He argues that schizophrenic patients require a specific form of psychotherapy, geared to their specific deficits, vulnerabilities, symptoms, and defenses. He does not recommend