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As Kurzweil (1989) memorably remarked: “Every country creates the psychoanalysis it needs, although it does so unconsciously” (p. 1). The same could be said of the types and applications of psychoanalysis, which, alas, have become far less imaginative and far narrower than might have been expected from Freud's original ambitions. Long enshrined rituals of practice, the choice by most analysts to work only in outpatient treatment with nonpsychotic patients has contributed to the marginalization of the field, even as the need for its powerful healing powers has become increasingly urgent at a time of such widespread distress in the world.
In this new book, Danielle Knafo, a psychoanalytic psychologist, and Michael Selzer, a psychiatrist specializing in schizophrenia, seek to restore some of the adventurousness and creativity that were the original hallmarks of psychoanalytic practice. Like other inventive and committed clinicians before them (e.g., Fromm-Reichmann, 1950; Karon & VandenBos, 1981), who sought to push against a too-comfortable and formulaic form of practice, the authors focus on psychotic disorders, insisting that they can be successfully treated using psychoanalytic methods, provided that the analyst understands the complexities of such work and has the patience and fortitude to persist despite its challenges.
The authors clearly set out their core assumptions: “Many therapists focus on eliminating or managing symptoms rather than exploring them. … Our approach is very different. We believe in viewing symptoms as adaptive measures and meaning-making systems” (p. 108). They are well aware of the high stakes of such work. “Psychotic symptoms are a sign that a human being is fighting for their life” (p. 110), and they see it as their job as therapists to fight alongside that person, regardless of the pace or length of the struggle. For some patients, what is most important is that the therapist “share the patient's experience, accompanying but not interpreti