Psychoanalytic Psychotherapy and Psychoanalysis of Near Psychosis

Abstract

I divide near psychosis into two categories: those who are near psychotic in ideas and attitudes only, and those who are also near psychotic in behavior. In addition, illness etiology of near psychosis varies from formes frustes of schizophrenia, manic depressive illness, organic brain syndromes, severe trauma, severe character pathology and its various subtypes, and combinations of these etiologies. Because of this variation of illness phenomena, the literature on psychoanalytic psychotherapy technique with near psychotic patients varies a great deal as to relevant psychodynamics, tactics of intervention, and types of treatment. The psychodynamic issues range from focus on narcissism, aggression, and splitting defenses (Kernberg, 1975), to focus on separation anxiety (Adler, 1983), to focus on infantile abandonment/depression (Masterson, 1972). The tactics range from consistent confrontation (Kernberg, 1975), to empathic support (Adler, 1983), to limit setting (Masterson, 1972), to supportive psychoanalytic treatment (Kohut, 1971), to so-called unmodified (neo)classical psychoanalysis (Porder et al., 1983). (For a review of dynamics see Gunderson, 1984; Frosch, 1990; or Gabbard, 1990.)