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During more than 17 years, I have conducted a study directed toward evaluating the efficacy of psychoanalytic therapy with few parameters in the office treatment of schizophrenic individuals. All prospective patients under the age of 50 years who suffered from borderline or overt schizophrenia or schizoaffective psychoses were included. The 17 patients who supply the data for this report exclude chronically regressed, “back ward” individuals, and all had average or superior intelligence. Some were seen at reduced rates. No waiting list was kept; patients were accepted when they were referred and therapeutic hours were open.
In the present series, the psychotic core has been altered fundamentally within two years, as a rule. All but three of the patients developed transference neuroses which were usually resolved.
Under the term “psychotic core” Bychowski(5) subsumed three points of special interest for the understanding of future psychotic development: (a) persistence and prevalence of archaic forms of functioning such as magic thinking and thinking on the original concrete level; (b) persistence and prevalence of such primitive mechanisms as introjection, primary identification and projection, though of universal significance for every mental functioning, assume the leading role and culminate in paranoid formations in individuals under consideration; and (c) splitting of the ego, occurring according to the original highly ambivalent attitudes of the child toward essential figures of his environment.
I submit that psychoanalysis can be used for the successful treatment of borderline and schizophrenic patients of the types included in this study, and that countertransference problems may constitute the major obstacle to the psychoanalytic treatment of such patients. It remains moot whether successful outcome depends upon special qualifications of the therapist. My data suggest that the professional and theoretical orientation of the analyst is a major determ