Response by L. Bryce Boyer

I am deeply grateful to the discussants for their thoughtful comments and penetrating questions. Their choice is happy, since they encompass a group who have widely varying theoretical viewpoints concerning, and employ vastly divergent technical procedures in, the treatment of borderline and psychotic patients. Their selection accurately emphasizes that there is as yet no psychoanalytic concensus concerning either theory or technique and that all avenues must be explored rigorously.

Before I respond to the individual discussants, I wish to stress that this interim report presents the theoretical orientation, methodology and, perhaps in a too-condensed form, the results of an empirical study. It is submitted that those results indicate that psychoanalysis conducted with techniques consistent with adherence to the structural hypothesis, including use of the couch, benefits some schizophrenic patients and may indeed be the treatment of choice for them.

I have not, of course, claimed that any patient has been “cured.” I have not had the opportunity to use the same methodology in the treatment of patients who have been long and continuously confined to institutions. Whether psychoanalytic treatment as defined by Freud and stated above by Dr. Bychowski could be used exclusively in their care remains a moot point, since, to my knowledge, no systematic and rigorous study has been done to test the hypothesis. The work of Fromm-Reichmann and Searles and some of their followers and of a few Kleinians, such as Dr. Rosenfeld, seems to me to suggest that such a study might show that psychoanalytic treatment could be used effectively in their therapy.

Obviously I claim no originality because of

my adherence to the “so-called ‘classical’ procedures” in the treatment of psychotics. As I have noted elsewhere,1 many other analysts—some of whom practiced during the period when the topographical theory represented the furthest advance of psychoanalytic thought—have cleaved to psychoanal