Discussion of L. Bryce Boyer's Article, Office Treatment of Schizophrenic Patients by Psychoanalysis

Dr. Boyer's paper is of particular interest to me as he uses the psychoanalytic approach to schizophrenia without any alteration of his usual technique. He disagrees with all seductiveness and fostering of the positive transference;

he avoids role playing and resists all attempts of the schizophrenic patient to make him change his analytic role by manipulation.

I have in my own work with acute and chronic schizophrenic patients adhered to a technique where the essential features of psychoanalysis are retained, namely, detailed interpretations of the transference neurosis or psychosis in all its negative and positive aspects without the use of reassuring or educative methods. What the schizophrenic patient seems to value most as the analysis progresses is the analyst's capacity to convey what he understands from the patient's verbal and nonverbal communications in interpretations and not by action.

It is, of course, typical for the psychotic, particularly the schizophrenic patient, to attack what he needs most. So he constantly seems to attack the analyst's state of mind, his sanity and capacity to function, because he envies it and because it makes him aware of his own madness.

It is here valuable to differentiate the behavior of the nonpsychotic and psychotic part of the patient's personality. One may say it is the sane part of the patient which values the capacity of the analyst to function, while the psychotic part hates the analyst's sanity and tries by manipulation and confusion to force him into collusion. I believe this desire for collusion is often mistaken by psychotherapists as a need for symbiosis and therefore is not resisted. I have often found that the patient's psychotic excitement increases when he believes he has forced the analyst out of his analytic role. The excitement implies that the psychotic parts of the patient have experienced this as a triumph not only over the analyst but over his own saner personality. This is one of the reasons why it i