Some observations on individual psychotherapy with psychotics

Summary

In this paper, some observations have been presented on psychotherapy with psychotic patients at Boston State Hospital. Two main problems producing general reluctance to treat psychotic patients have been discussed: first, the distress created in the therapist in this type of treatment; and, second, the nature of the defenses of the psychotic patient. A program designed to meet these problems was described. Methods of establishing a relationship with the overly-aggressive patient and the mute patient were suggested. Illustrations were made of certain general problems arising during therapy. Chief among these were the criticisms of the therapist by the patient and the sensitivity of the patient. The therapist, rather than making defensive maneuvers, must accept the patient's criticism as being a problem for the patient. In the same way the patient's sensitivity should be viewed as the patient's problem and should be discussed whenever it arises. It was suggested that defensive maneuvers by the therapist are a block to therapeutic progress by the closing off of important areas from further discussion.