Introjection of the Therapist

There are a few rare patients in whom the therapeutic process appears to revolve in the main around the patient's introjection of the therapist. This kind of patient is quite difficult to discern before the process begins and presents some very special problems. In more than twenty years of practice I have had three patients who particularly displayed this method of dealing with their problems. With one of these patients the therapeutic outcome was an outstanding success. With the other two the therapy essentially resulted in failure. I would like to present these three patients in some detail in order to raise some questions about how one might spot this process as it occurs early in therapy, how the therapy should be handled, how some of the pitfalls might be foreseen and perhaps eliminated. Unfortunately, I have more questions than answers about these patients, but I do know that with the last patient I was able to spot the difficulty more quickly and to transfer him to another therapist rather than prolong what I am quite sure would have been an unsatisfactory treatment process.

The first patient was a schizophrenic boy of nineteen when he was first seen by me. He had been in a state mental hospital for three years, but one of the progressive ones where patients are treated actively. He had had three previous therapists at the hospital and had acquired, among the resident staff, the reputation of bȩte noire. He had been hospitalized because he had fits of screaming which came on when he thought that some day he was going to have to die. He screamed so loudly and uncontrollably that he used to awaken the whole neighborhood.