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To the Editors: The article by Dr. L. Bryce Boyer [“Office Treatment of Schizophrenic Patients by Psychoanalysis,” The Psychoanalytic Forum, Vol. 1, No. 4] has moved me to make some comments and ask some questions, derived partially from 12 years experience in psychoanalytic psychotherapy with many borderline and psychotic patients who, I believe, are similar to those with whom Dr. Boyer has been working. They have been treated largely in the office, although three or four have been hospitalized for short periods, usually under the care of another psychiatrist, and a few have been on psychotropic drugs.
In terms of the psychoanalytic structural theory, how do we understand psychosis so as to treat it? Dr. Boyer does not make entirely clear how his approach to treatment derives from theory.
First of all, his patients seem to be schizophrenic in the broad modern sense, rather than in the classical narrow one of Kraepelin and Bleuler. Most seem to be borderline, chronic undifferentiated, or schizo-affective cases, rather than catatonics, hebephrenics, etc. Although they might require hospitalization for short periods, they are not back ward cases. It appears that Dr. Boyer is not suggesting or trying psychoanalysis for such cases.
Second, it is difficult to determine where Dr. Boyer draws the line between psychoanalytic therapy and psychoanalysis proper, but his parameters seem considerable, even though his patients use the couch four times weekly and free associate.
In a panel on the ego (American Psychoanalytic Association Meeting, Spring, 1966), Dr. Robert Waelder made a historical comment about the nature of analysis. As he put it, in the beginning the analyst tried to find out what the patient wanted to do and let the patient know. Later he learned to wonder what the patient was afraid of in himself, and still later, what the patient does when he is frightened.
Most analysts now will agree that analysis is the study of the unconscious and of ego-id conf