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As the inside cover description of this volume states, Karon and VandenBos “present the clinical issues and technical approaches involved in work with severely disturbed patients. The authors argue that the treatment of choice is psychotherapy and
that such treatment can be as successful for schizophrenic patients as it is for neurotic patients, although the process may be longer.”
The volume provides a thorough historical overview of the clinical approaches to schizophrenia, including the thinking of contemporary clinicians. Drawing from ample case material, Karon and VandenBos give a full clinical picture not only of the patient and his or her family, but also of the therapist's own countertransference. They regard the clinical ingredients in the patient's progress to be the patient's developmental experience and the therapeutic interaction between therapist and patient.
The book is divided into three sections. The first section contains an historical overview of the treatment of severe mental illness, a fairly comprehensive description of the developmental aspects of schizophrenia, and a discussion of the role of unconsciously malevolent parenting during the oral phase, which leads to schizophrenic pathology. The authors' understanding is that the character structure of borderline and psychotic individuals serves as a defensive system against painful negative affects, primarily rage and terror. Karon and VandenBos convey a sympathetic and therapeutic attitude toward the parents of the patients.
The authors repeatedly stress the injustice “implicit in the practice of psychotherapy in our society [in] that the best trained and most experienced psychotherapists, the fully trained psychoanalysts, typically treat neurotic patients possessing social and economic resources sufficient to receive adequate treatment while the least trained and most inexperienced therapists are generally assigned the most severely disturbed psychotic patients who have little or no social or