Psychotherapy Can Be Helpful for Schizophrenics

Abstract

Karon's work with Mr. X reflects the model that he and I use generally in doing psychoanalytic psychotherapy with schizophrenic patients. In my experience, this work is frequently met with considerable skepticism and at times outright antagonism from the professional mental health community. In this commentary I explore 10 possible reasons for these negative reactions and why I believe the reactions are off target from the central clinical fact that Karon's model has a track record of success. These reasons include such areas as the roles of diagnosis, medication, a detailed developmental history, the therapist's distinctive personality and style, and the therapist's level of activity in treating patients diagnosed as schizophrenic.key words: schizophrenia; psychoanalytic treatment ____________________________________________________________________________ It was enjoyable and informative to read the clinical case study of Mr. X by Bertram Karon (2008). I have known Dr. Karon since 1967, and I have heard him present in lectures, seminars, and at conferences many times. As I read his words, I can "hear" him saying them. As always, I hear his depth of understanding and appreciation of the experiential world in which an individual with schizophrenia lives, and I hear his intense efforts to help build a "safe world" in which the patient with schizophrenia can feel less threatened and start tentatively and inconsistently to relate and communicate with the therapist, initially in a vague, complex, and difficult to understand manner. I have found his style, technique, and his actual words in such therapy to be very helpful to the typically terrified individuals with schizophrenia. Dr. Karon influenced me early in my training in conjunction with my role as the Senior Research Coordinator on the program he directed, the below-described "Michigan State Psychotherapy with Schizophrenics Project." Much of my clinical style with severely disturbed patients is modeled after him. My own clinical success with schizophrenic patients is likewise similar to his, and I have lectured broadly on the psychotherapeutic process of treating individuals with

Starting off on the right foot: Common factor elements in early psychotherapy process.

“…There are many ways in which therapists can normalize peoples' concerns and communicate realistic confidence in the treatment process. The following statements highlight ways for helping individuals feel less isolated with their problems and gain a greater sense of confidence in the treatment: “the types of experiences you have described certainly sound distressing, many people come to therapy with similar concerns, and they are exactly the kind of concerns that therapy can be helpful with,” “I'm glad you came in to seek help with this,” “I'm really hopeful that our work together will be beneficial,” “I have seen many people describing similar feelings get significant relief from treatment.” Consider the following statement made to a patient from VandenBos (2008): That shouldn't have happened to you, it shouldn't have happened to anyone, but something awful did happen to you, and it hurt you, and anyone who experienced what you experienced would have symptoms just like you are having now, but you don't need to stay this way, it can be changed, and by talking and exploring your life and your experiences, you and I can change it, you will be able to better understand what did and did not happen to you, and you can think afresh about the nature of interpersonal relationships, so you can experience new events, such as our work together, with a fresh, new view of events (p. 41).…”