To work with the severely disturbed is to be frightened, angry, depressed, bored, discouraged, or confused because the patients are frightened, angry, depressed, bored, discouraged, or confused, although patients also deal with their confusion by clinging to premature closure. False beliefs usually solve an immediate problem but in the long run make a satisfying life impossible.
Rarely are student therapists told that being confused is essential to successful work with severely disturbed patients. Moreover, good therapy with severely disturbed patients almost always involves improvisation. If what we try works, we continue it. If it does not work, we stop and try something else.
Also discussed will be conscious resistance (the most important
difference between working with psychotics and working with neurotics), its sources and handling, phrasing of interpretations, and frequency of sessions.
Bertram Karon, Ph.D Professor, Psychology, Michigan State University. Former President, Division of Psychoanalysis (39) of APA and of the Michigan Psychoanalytic Council. Approximately 160 publications including the book (with G.R. VandenBos) Psychotherapy of Schizophrenia: The Treatment of Choice, and the 2001 Fromm-Reichmann Memorial Lecture at the Washington School of Psychiatry, “The Tragedy of Schizophrenia Without Psychotherapy.” He has received awards for clinical insights and technique, research, and teaching from Division 39, APA Graduate Students, the American Psychological Foundation, the United States chapter of the International Society for the Psychological Treatment of Schizophrenia and other psychoses, the International Center for the Study of Psychiatry and Psychology, the International Federation for Psychoanalytic Education, the Appalachian Psychoanalytic Society, and the New York Society for Psychoanalytic Training. Dr. Karon is in
private practice in East Lansing.
Patience is one of the many components of the analytic attitude. It is generally regarded as an invaluable attribute for a therapist to possess, yet it is usually treated as if it goes without saying. Regarding its inverse, it is hard to imagine a therapist characterized by impatience as very helpful with most clients. In this paper, the use of patience by the therapist is explored, especially in relation to certain issues of technique. As well, some developmental aspects regarding the acquisition of patience will also be considered. Clinical vignettes will illustrate the concepts.
David Klein, Ph.D. is the President of MPC after serving as MPC Treasurer for 5 years. Dr. Klein is the Editor of the Michigan Psychoanalytic Council Bulletin and is currently the instructor for MPC’s Continuous Case Conference. He practices psychotherapy and psychoanalysis in Ann Arbor, working with children, adolescents and adults
The relationship between psychoanalysis and psychotherapy remains confusing, ambiguous, and problematic for psychoanalysts and psychotherapists. Volumes devoted to this topic have not been helpful in promoting an understanding of the similarities and differences of the therapies because the concepts and formulations that have been used are on a level of abstraction that is distant from clinical experience. With an experiential perspective and the clinical theory of psychoanalysis, greater clarity can be achieved in understanding the relationship of the two therapies. In developing my premise, I demonstrate that my approach and technique with all patients whether the therapy is psychotherapy or psychoanalysis is similar, i.e. to reduce the effect of resistances against telling one’s story that will increase the capacity to be in touch with oneself and experience an increase wholeness and solidity of self.
In psychoanalysis and at times in psychotherapy an emotional relationship develops, that becomes the subjective organizing center of the psychoanalysis and psychotherapy. The subjective organizing center promotes the progress of the therapy and envelopes the resistances that retard the progress of the therapy. For the author, the term psychotherapeutic third captures this subjective entity. In psychoanalysis in addition to the development of a psychotherapeutic third a co-construction of an ideal fostered by the analyst also develops.
The ideal is based upon a conviction that by consistently applying the analytic attitude the resistances that analyst and patient are struggling to overcome which are enveloped in the psychotherapeutic third will be reduced enabling the patient and analyst the achievement of greater freedom and autonomy. This conviction of the analyst that becomes the catalyst for the co-constructed ideal generally develops in psychoanalytic training while being immersed in the psychoanalysis of several patients with the support of an institute and the guidance of supervisors.