Psychodynamic Therapy

Editor Brian Martindale, mail to bm@bmakm.plus.com

 

Introduction to Psychodynamics and Psychosis

     It is important to distinguish between

               a) psychodynamic models of understanding the mind of the person with psychosis

                             Psychodynamic understandings can be used to help understand a person in any situation or setting and be integrated with many therapeutic approaches.

                   

               b) psychodynamic or psychoanalytic therapies.

                             Psychodynamic therapies for psychosis are specially adapted therapies based on psychoanalytic theory and modifications of psychoanalytic technique.

 

We stress this point as an understanding of psychodynamics may be useful for anyone interested in psychosis,

whereas providing therapy requires special training

What is psychosis from a psychodynamic perspective?

 Brian Martindale

A way of thinking about realities

The intact mind is able to recognise and integrate the many realities a person has to contend with at any point in time.

By realities, I mean not only the realities external to the person (e.g. how other people are behaving, the social context and 'rules' and of course the rules of the physical environment such as gravity and time) but also internal realities of feelings, conscience, memories, of one’s biology and physical state (e.g. hunger, sex, tiredness).

Much of what is being registered and integrated is unconscious. The ego is a term often applied to the ‘integrating mind’ and contributes to the sense of self (though ego and self are not the same).

In psychosis, aspects of the mind cannot integrate aspects of ‘reality’ – or aspects of the mind have been overwhelmed, perhaps shattered, leading to a feeling of annihilation or a fear of annihilation in acute situations. This may be because of something specifically too disturbing (something qualitative e.g. something very shameful or humiliating) or something that is also quantitative e.g. too many losses of key people in one’s life in a short time).

Either as a result of the mind being overwhelmed or perhaps to prevent it being overwhelmed, the mind reorganises itself or part of itself to create a new reality with the aim of circumventing the painful issue. In psychodynamic terms, both the creating of a new reality and the particular methods of doing this are what I mean by psychotic. In doing this, it uses similar devices that we all use in our dreams.

Here we give some simplified examples.

  • A young man who is in danger of feeling he will never have a girlfriend, starts hearing a nice female voice (this is called hallucinatory wish fulfilment)
  • A religious person who has renounced anything sexual about herself starts to feel persecuted by beliefs that there are plots to infiltrate her room with sexual chemicals
  • A woman who cannot have children becomes thought disordered when relatives with young children visit (the thought disorder protects her from too painful thoughts)
  • A person who did a great deal of damage in a fit of rage is admitted to hospital, and the next day has no memory of the event and claims they have been wrongly detained and accuses the psychiatrist of being an impostor!!

Common to these examples is some form of splitting (or fragmentation) of reality by the mind, denial of reality and often projection (e.g. of distorted personal issues outside of self into another or the external world). Reaction formation (turning something into its opposite) is common and linked with wish fulfilment. The intuitive person can recognise meaningful aspects of the person’s life issues in the psychotic symptoms, but one needs to be careful about reflecting this back to the person as the point of the psychosis is that something has been intolerable. When a person has been psychotic for a while all kinds of secondary phenomena and further distortions occur as well as withdrawal from aspects of life and relationships. Early intervention is therefore most important

Seven important points

1)      A psychodynamic view is that psychosis can have a purpose in relation to mental pain.

                   In non-psychotic problems, the person SUFFERS from mental pain CONNECTED with their reality and feelings.  

                   In psychosis people come to or for attention where the psychosis has not been successful enough in transforming mental pain or the person causes problem for others (e.g. in mania)

2)     Psychodynamic understandings are quite compatible with hypothetical biological understandings of psychosis or vulnerability.

                   For example there is no inherent reason why we may not all have different sensitivities to mental pain stemming from constitutional differences.

3)      The psychological methods of dealing with pain in psychosis, fragmentation, denial splitting, projection, wish fulfilment and so on – are methods common to all of us to varying degrees.

                   The important point is the degree to which the integrating mind has been overwhelmed or the area of the mind involved

4)       The concept of culture wide psychosis is important where denial of reality (and projection) is shared in a population because of too painful implications.

                   Examples might be the tendency to deny climate change, the belief in a physical life after death where it has the function of denying the painful reality of death and loss of self and others,

                   Aspects of the nature of war and relations between nations or religions.

5)        Nurture. Psychodynamic thinking is that the state of mind prior to psychosis is often relevant.

                Many people who experience psychosis in their adult lives have had earlier traumas, not only abuse but losses.

                Adult experiences may awaken earlier experiences and overwhelm the person.

                Perhaps more important but less obvious are nurturing situations in which the person has been excessively protected or prevented from experiencing feelings and do not have the mental strength to manage adult life or separation from the family.

6)        Repression and symbolisation.

                      An intact mind does not just register realities, it also ‘digests’ realities.

                      For example love and aggression are transformed in all of us through normal mental repressive barriers into interests and behaviours that contribute to the richness of the sense of being alive and living.

                      Here psychoanalysis from its early days has hypothesised about the complex relation between somatic forces and their mentalisation. In psychotic areas of the mind,  there are difficulties in symbolisation and ideas and thoughts are taken to be realities, not representations

7)        Psychotic and non-psychotic

                     None of us are unitary, our sense of self can change quickly.

                     It is most important for many reasons not to think of someone, ourselves included, as psychotic or non-psychotic.

                     It is quite possible to be actively psychotic and yet another aspect of ourselves can be functioning very well in relationship to realities (point one). An important issues is the relation between the two which can be very variable.

Further reading

Brian Martindale & Alison Summers. The Psychodynamics of PsychosisAdvances in psychiatric treatment (2013), vol. 19, 124–131, doi: 10.1192/apt.bp.111.009126 see abstract

Richard Lucas. The Psychotic Wavelength. 2009. Routledge

 

 

Psychodynamics, attachment and psychosis, by Allison Summers

Attachment theory

Attachment theory originates with the psychoanalyst, John Bowlby, who defined attachment as an affectional bond with a 'differentiated and preferred individual' or attachment figure. Attachment figures are seen as providing a safe haven in times of distress and threat, as well as a secure base from which to explore the world.

Attachment bonds develop in infancy, when they are thought to have an evolutionary survival value through ensuring that the caregiver remains close to the vulnerable infant. When caregivers are able to offer a good enough response to an infant's needs, a secure attachment develops whereas in less favourable circumstances, various forms and degrees of insecurity are possible. Attachment patterns in early life affect the individual's later attachment relationships and the attachment system remains important throughout the life cycle.

 

The relationship between psychodynamic and attachment approaches

Attachment theory developed out of a branch of psychoanalysis which regards human beings as having a primary instinctual drive to relate to others. However over several decades the attachment and psychodynamic fields developed along divergent paths, with work on attachment focusing on empirical research and cognitive aspects.

More recently there has been recognition of the extensive common ground between the two approaches. In addition, attachment research has provided confirmation of many psychodynamic theories about the way psychosis develops and persists.

There are also areas of difference between attachment and psychodynamic thinking. It may be that bringing together ideas from the two fields could offer new possibilities for development of our understanding of psychosis and of more effective therapies.

 

Different names for similar concepts

Often the psychodynamic and attachment fields have different names for similar concepts. For example the important psychodynamic concept of containment, refers to how a relationship may allow emotion to be tolerated, digested, and become thinkable rather than avoided. This seems to have much in common with attachment ideas about how a secure attachment enables emotion to be reflected on (or, in attachment terms, mentalised).

Attachment theory categorises attachment relationships according to the degree and form of insecurity within them. Some of the more extreme defensive constellations of psychodynamic theory can be seen as similar to more extreme patterns of attachment insecurity, for example schizoid patterns may be likened to avoidant attachment, histrionic to hyperactivating and borderline personality features to disorganised attachment.

Perspectives on the development of psychosis

Attachment theory has most in common with the psychodynamic approaches which are described as relational. Like attachment theory, these theories are based on the idea that early relationships shape our subsequent experience of ourselves and other people, and the emotional quality of relationships.

Like attachment theories these psychodynamic theories see psychosis as a response to unmanageable negative affect. They hold that adversity in early relationships can affect mental development in a way which increases vulnerability to psychosis. Attachment theory and research identify a number of specific ways in which this can happen, including by affecting our abilities to regulate emotion and to reflect on our own and others' thoughts and feelings (ie to mentalise).

Psychodynamic and attachment practitioners both use approaches to understanding an individual that link life history with later experience and behavior. Psychodynamic approaches differ in their attention to the role of unconscious emotion and defences and in drawing on a wider range of clues to these for example clues in language, dreams, psychotic experiences, and in practitioners’ responses to their clients (countertransference).

Therapy

Therapies based on attachment theory and research aim to use techniques derived from this to enhance the security of the client's attachment. Some new varieties of therapy are being developed with this aim, often combined with cognitive approaches.

Relational forms of psychodynamic therapy could be seen in some ways as attachment-based therapies, even though not explicitly calling themselves this. They certainly have many features likely to increase attachment security, including, for example, the focus on clients' moment to moment experience with the therapist, and the way in which a skilled therapist's responses are attuned to the client's emotional state and capacities. More supportive forms of psychodynamic therapy may have additional features likely to enhance attachment, for example interventions that help mentalising. In the longer therapies which are more likely with psychodynamic than cognitive approaches, a relatively secure attachment relationship with a therapist may perhaps allow a person to develop new capacities and new ways of experiencing the world.

There is still a lot of uncertainty however around what it is that enables any helpful therapy to achieve its effects. There is also uncertainty about what approaches are likely to be most helpful for any particular individual.

It seems almost certain that aspects of therapists’ own attachment styles and related features will have a significant contribution to therapeutic relationships; their capacity to be flexible in their attachment style is probably also of considerable importance in sustaining the therapeutic relationship.

Despite the uncertainties, many believe that attachment theory and research have a useful contribution to make to the ongoing understanding and development of therapy for individuals who experience psychosis. It seems important also not to overlook the role of attachment in existing approaches which are named psychodynamic rather than attachment therapy.

Further reading

Burke E, Danquah A, Berry K (2015) Clinical Psychology and Psychotherapy A Qualitative Exploration of the Use of Attachment Theory in Adult Psychological Therapy. Clin. Psychology. Psychotherapy. Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/cpp.1943, see abstract

Harder S. (2014) Attachment in schizophrenia: implications for research, prevention and treatment. Schizophrenia Bulletin, 40,6, 1189-93. See full text

Schwannauer, M. and Gumley, A (2014) Attachment theory and psychosis. In: Attachment theory in adult mental health. Eds. A Danquah and K Berry. Abingdon: Routledge. See Book on amazon

 

The development of psychodynamic models of understanding psychosis over the last century, by Maurizio Peciccia.

Federn, Abraham and Jung were amongst the first psychoanalysts to work with psychotic individuals. Federn, (1929) maintained that the mind was invaded by the unconscious and by dreams because the ego had become disinvested of libidinal love weakening its borders leading to fragmentation and invasion externally by reality and internally by dreams.

Abraham (1908) and Freud (1917) had previously described psychotic internal representations of others as depriving of love and distant but distinct from the ego. Federn, highlighted the opposite situation: due to the weakness of its boundaries, the Ego and objects merge.

Jacobson (1954) linked her theories to those of Federn when she described the fusion in psychotic patients between the representation of the self with the representation of the others.

Contemporaneously, Klein (1946), described projective identification as creating a phenomenon similar to the fusion between self and others and their representations. In projective identification unacceptable aspects of self are located outside of self and into others and their internal representation. Hanna Segal, pointed out that “the difficulty of forming or using symbols is one of the basic elements in schizophrenic thinking”. Between two different objects, either no interest, no symbolic link develops or, on the contrary, interest is excessive: the two objects coincide and become the one object; in place of the symbol there is then “symbolic equivalence” (Segal, 1950). (Note – 'Internal object' is a term used commonly in Kleinian theory to denote an inner mental and emotional image of an external figure, also known as an external object, together with the experience of that figure. The inner world is seen to be populated with internal objects.’)Mahler (1952, 1958) differentiated two types of psychoses calling them symbiotic and autistic. Symbiotic psychoses are characterized by the fusion of the other and the self. In autistic psychoses, on the contrary, there is a lack of affective awareness of the presence of others: the other does not exist in the subject's perception; the children do not perceive their mothers as living beings.

Winnicott (1965) described a now widely recognized theory of psychotic disorders of the self. He stated that “holding” deficiencies in early childhood affect the cohesion and unity of the self of the future psychotic patient (Winnicott & Khan, 1965) creating a future vulnerability in the face of later stresses.

In the middle of the 1980's Stern (1985) elaborated a revolutionary model of child development according to which many states of the self contemporaneously evolve integrating, without losing any of their actual and potential autonomy even in adult life. According to the empirical observations of Stern, the child has, from the first days of life, the ability to differentiate himself or herself from the environment (e.g. Rochat, Hespos, 1997). At the same time, the infant is able to establish close symbiotic ties with other people and external objects -e.g. neonatal imitation- (e.g. Meltzoff, Moore, 1977).

While Mahler's model of child development is linear –i.e. it proceeds continuously from symbiosis to separation- Stern's model is circular because it assumes that the self of the child circularly and repeatedly oscillates between states of contact-fusion and states of separation-differentiation. Stern's developmental model of the self directly or indirectly influenced contemporary psychoanalysis. Today it is widely accepted that in emotionally healthy human beings, different self-states can coexist in a sufficiently balanced way - meaning that they push the person at the same time both toward union with others and toward separation from other- (Auerbach, Blatt, 1996; Benedetti, Peciccia, 1994; Bolognini, 2004; Mentzos, 1991; Ogden, 1992; Solan, 1991).

In this theoretical context, psychosis has been linked to a too intense conflict that divides and shatters the self, resulting in a ‘crack’ between the drives towards union with and separation-from the other. The severity of this conflict may leading to the person experiencing a dissolution of the self and a sense of psychic death (Auerbach, Blatt, 1996; Green, 1986; Mentzos, 1991; Peciccia and Benedetti, 1996). It has been proposed that the conflict of the psychotic patient between identification, closeness and even union on the one hand and differentiation processes on the other might be have its psychological origins to an antecedent poor integration of opposite states of the self, called “symbiotic and separated self” (Peciccia and Benedetti, 1996).

Others outside of no psychoanalysis describe, with other words, psychotic phenomena similar to that of the lack of integration between different self states.

According to the phenomenologist Fuchs (2015) psychotic patients lack an independent “third position” from which they could compare and integrate their own and another’s point of view. Intersubjectivity which is based on the ability to oscillate between our own point of view (the “ego-centric”, embodied perspective) and the other’s point of view (the allo-centric, decentred perspective) is therefore, in some psychotic persons, deeply disturbed. Fuchs stated (2015)“delusions typically manifest themselves as a peculiar inability or refusal of the patient to adequately take the other’s perspective into account. Nevertheless, regarding content, delusions notoriously show a pervasive reference to others by whom the patient feels observed, spied at, persecuted”.

From a neurophysiological point of view evidence has accumulated of psychotic dysfunctions involving both the mirror neuron system (Metha et al.2014), correlated to self-other identification (Olds, 2006) and the multisensory integration network correlated to self-other differentiation (Gallese and Ebish, 2013). Furthermore Ebisch et al., (2013) illustrated abnormal connections between the mirror neurons system and the multisensory integration network. These transdisciplinary correlations provide empirical evidence for ideas arising from psychodynamic oriented psychotherapies.

Further reading

(links to articles are provided if possible, sometimes in another form, for instance as chapter in a book instead of an article or a comparable article of the same author.)

Abraham K (1908). The psycho-sexual differences between hysteria and dementia praecox. Selected papers on psycho-analysis. London, 1927. Die psychosexuellen Differenzen der Hysterie und der Dementia praecox. Zbl. Nervenheilk. Psychiat. N.F. 19, 521. (40-1, 65, 70, 76-7) Chap. II see book go to chapter 2

Auerbach, J. S., & Blatt, S. J. (1996). Self-representation in severe psychopathology: The role of reflexive self-awareness. Psychoanalytic psychology, 13(3), 297-341 see full text article

Benedetti, G., & Peciccia, M. (1994). Psychodynamic reflections on the delusion of persecution. Nordic Journal of Psychiatry, 48(6), 391–396.see abstract

Bolognini, S. (2004). Psychoanalytic empathy. Free Association Books London. see book on amazon

Ebisch, S. J., Salone, A., Ferri, F., De Berardis, D., Romani, G. L., Ferro, F. M., & Gallese, V. (2013). Out of touch with reality? Social perception in first-episode schizophrenia. Social cognitive and affective neuroscience, 8(4), 394–403. See full text Pdf

Federn P (1929). The Ego as subject and object in narcissism. In: Ego psychology and the psychoses. London: Imago (1953). See abstract

Freud S (1917). Introductory Lectures on Psycho-analysis (Part III). Lecture 26: The libido theory and narcissism. SE 16, 414.see chapter in another book

Fuchs T (2015). The intersubjectivity of delusions. World Psychiatry 14:2-June 2015 see full text article

Gallese, V., & Ebisch, S. (2013). Embodied simulation and touch: The sense of touch in social cognition. Phenomenol. Mind, 4, 269–291.see full text article

Green A. (1986). On private madness. Madison CT. New York: Int. Univ. Press see book

Jacobson, E. (1954). Contribution to the metapsychology of psychotic identifications. Journal of the American Psychoanalytic Association.

Klein M (1946). Notes on some schizoid mechanisms. In Envy and Gratitude and Other Works, 1946-1963 New York: Delacorte, 1975 pp. 1-24 see book on google

Mahler, M. S. (1952). On child psychosis and schizophrenia: autistic and symbiotic infantile psychoses. The psychoanalytic study of the child. see comparable article

Mahler, M. S. (1958). Autism and symbiosis, two extreme disturbances of identity. The International journal of psycho-analysis, 39(2-4), 77. See first page of Pdf

Meltzoff, A. N., Moore, M. K. (1977), Imitation of facial and manual gestures by human neonates, Sciences, 198, pp. 75-78. See full text article

Mentzos, S. (1991). Psychodynamische Modelle in der Psychiatrie. Vandenhoeck & Ruprecht.

See book on amazon

Ogden TH (1992). The Dialectically Constituted/decentred Subject of Psychoanalysis. II. The Contributions of Klein and Winnicott. Int. J. Psycho-Anal., 73:613-626 see abstract

Olds, DD (2006), Identification: psychoanalytic and biological perspectives. J Am Psychoanal Assoc. 54/1 see abstract

Peciccia, M., & Benedetti, G. (1996). The splitting between separate and symbiotic states of the self in the psychodynamic of schizophrenia. In International Forum of Psychoanalysis (V. 5, page. 23–38). Taylor & Francis. see abstract

Peciccia, M., Mazzeschi, C., Donnari, S., & Buratta, L. (2015). A Sensory-Motor Approach for Patients with a Diagnosis of Psychosis.Some Data from an Empirical Investigation on Amniotic Therapy.Psychosis,7(2),141–151 see article in psychosis

Rochat, P., Hespos, S. J. (1997). Differential rooting response by neonates: Evidence for an early sense of self, Early development and parenting, 6, pp. 105-112. go to abstract

Segal H (1950). Some Aspects of the Analysis of a Schizophrenic. Int. J. Psycho-Anal. 31:268-278. P.270.see chapter in book Listening to Hanna Segal: Her Contribution to Psychoanalysis by Jean-Michel Quinodoz l

Stern DN (1985). The Interpersonal World of the Infant. New York: Basic Books. See book

Winnicott, D. W. (1956). Primary maternal preoccupation. Tavistock London.see chapter in book The Maternal Lineage: Identification, Desire, and Transgenerational Issues, Door Paola Mariotti

Winnicott, D. W., & Khan, M. M. R. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. Hogarth Press London. see full Pdf!

Extract from the Norwegian Guidelines for Psychosis

 

The Norwegian Guidelines are unusual in that they have a section that clearly supports psychodynamic approaches to psychosis and justifies them on a number of grounds including their unsuitability for random controlled trials the usual basis for contemporary mental health guidelines.

Translation may be approximate

Recommendation:

Psychodynamic treatment modalities can be used by educated health personnel to understand the experiences of patients with psychotic disorders.

After individual assessment adapted supportive psychodynamic psychotherapy, following phase-specific principles, can be offered in the nonpsychotic illness phases.

Psychodynamic

The term "psychodynamic" emphasizes the active interaction between the individual and the physical and psychological environment. Psychodynamic psychotherapy attends to the relationship between the individual and the environment as the primary focus area in the treatment process. The psychodynamic understanding therefore includes both knowledge of personal vulnerability and protective factors. Psychodynamic psychotherapy focuses on the ability to regulate emotions, understand vulnerable relational experiences and to provide insight into challenging relational patterns.

Psychodynamic therapies

Psychosis disorders were initially considered unsuitable for psychoanalytic oriented treatment (242; 243). In the 1940s, 50s and 60s psychodynamic treatment approaches were tried out, especially in the United States (244; 245), and they are also extensively used in modified form in our time (246). From this experience gained and further understanding of the complexity of the psychosis, the perspective has shifted from a treatment aimed at comprehensive personality change to a treatment more aimed at better coping with stress factors.

Patients with psychotic disorders have difficulties dealing with environments characterized by lack of structure and those with high emotional pressure. This has implications for the organization and scope of psychotherapeutic treatment. Modern psychodynamic psychotherapy for psychosis is anchored in a clear model, where the therapist presents him or herself in clear, actively participating manner and is supportive and open. The earlier techniques focussing mainly on the idea that interpretations of unconscious phantasy lead to change have been abandoned in favour of working with the individual’s vulnerable areas.

Ordinary or classical psychoanalytic approach is generally not recommended for people with psychotic disorders, because the unstructured format and mobilization of strong emotions can be stressful. Psychodynamic psychotherapy in psychosis will be psychodynamic based therapeutic conversations. The therapist must take into account the phase of psychosis disorder the patient is in, and know if the patient is psychotic or not.

In the psychodynamic approach it is important to establish a good working relationship both with patients and their families. The therapists must, based on psychodynamic theory, be able to handle negative reactions, transference reactions and their own feelings.

Psychodynamic based therapeutic conversations can be important when one follows a patient with psychosis in the overall treatment regimen, over time (247). Therapeutic meetings emphasize relationship building and try to help the patient to cope with stress better and relate to delusions in a better way. The therapist and patient should agree on what are the goals of the talks, and what is expected of both parties.

When the phase with active psychosis symptoms is over, the objective of the therapy is to prevent secondary complications such as those with relations with family, friends, school and / or work, and to reduce vulnerability to stress and work through the trauma of having been psychotic. If the patient is still psychotic, the objective is to build and maintain a cooperative relationship and help the patient to distinguish better between fantasy and reality (247).

Unlike cognitive models psychodynamic therapy has traditionally not had any defined length to the course of treatment, but has been adapted to the patient's individualisation process, symptoms and functioning. Psychodynamic psychotherapy is a treatment that is suitable in the work with ?? affect regulation and by focusing on vulnerable areas of the patient, areas that may be challenging in the relation to other people. In patients who are stable and in recovery psychodynamic psychotherapy can be useful for further assisting in integrating experiences and contribute to an improved sense of self as part of the recovery process.

There are few controlled randomized studies on psychoanalytic or psychodynamic psychotherapy in psychosis, mostly because the very character of these forms of therapy with its flexibility to the individual is unsuitable for this type of evaluation. (248).

Further reading

Freud S. On narcissism: an introduction [Zur Einfuhrung des Narzissmus]. part I of Joseph Sandler,Peter Fonagy,Ethel Spector, see google books

Freud S. The Unconscious. I: The standard edition of the complete psychological works of Sigmund Freud. Volume XIV, 1914-1916, On the history of the psychoanalytic movement, Papers on metapsychology and other works. London: Hogarth Press; 1957.See book on Amazon

Sullivan HS. The onset of schizophrenia. 1927. Am J Psychiatry 1994; 151(6 Suppl):134-9.see first page in annuals American Journal of Psychiatry 

Fromm-Reichmann F. Principles of intensive psychotherapy. Chicago: University of Chicago Press; 1960. See boo

Alanen YO. Vulnerability to schizophrenia and psychotherapeutic treatment ofschizophrenic patients: towards an integrated view. Psychiatry 1997;60(2):142-57. .see abstract

Rosenbaum B, Harder S, Knudsen P, Koster A, Lindhardt A, Lajer M, et al. Supportive psychodynamic psychotherapy versus treatment as usual for first episode psychosis: two-year outcome. Psychiatry 2012; 75(4):331-41.see full text article

Leichsenring F, Rabung S. Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. Br J Psychiatry 2011;199(1):15-22 see full text article

Recommended movies on psychodynamic therapy for psychosis

See speech Annita Sawyer, second part, she received therapy from Harold Searles

Barbro Sandin is an Honorary Lifetime Member of ISPS and one of the leading Swedish pioneers in the talking therapies of psychosis.Read about her see SPS page .Listen to her (a 4 minute video clip of her giving a talk about her psychodynamic work with English subtitles) and part 2

American East Coast pioneers in the psychotherapy of psychosis and the start of Chestnut LodgeListen to this video of Clarence Schultz

Clarence Schultz – talking about work with people with psychosis: Optimism and Mutuality in Treatment see you tube

Clarence Schulz on Attachment and Loss, see you tube

Clarence Schulz on Harry Stack Sullivan, see you tube he was a pioneer who highlighted interpersonal therapy Read about him Listen to a description of Sullivan’s early career Listen to a description of Sullivan’s approach and then see you tube

Recommended books on psychotherapy for psychosis

Fromm-Reichmann F. Principles of intensive psychotherapy. Chicago: University of Chicago Press; 1960. See book frontpage

Jackson, M., Williams, P. (1994) Unimaginable storms: a search for meaning in psychosis. London: Karnac. See book sample

Jackson, M. (2001) Weathering the storms: psychotherapy for psychosis. London: Karnac see book on amazon

Williams, P. (1999) Psychosis (madness) London: Institute of Psychoanalysis see book on google

Lucas, R. (2009) The psychotic wavelength: A psychoanalytic perspective for psychiatry. Hove: Routledge. See amazon

Karon, B.P. & VandenBos, G.R. (1981). Psychotherapy of schizophrenia: The treatment of choice. New York: Rowman & Littlefield. see book frontpage

Karon, B. P. (2003). The tragedy of schizophrenia without psychotherapy. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 31, 89-118.

Charles, M. (2011). Working with Trauma: Lessons from Bion and Lacan. New Imago see book. Working with Trauma: Lessons from Bion and Lacan by Marilyn Charles takes concepts from the psychoanalytic literature and translates them into user-friendly language. In this book, Charles focuses on clinical work with more severely disturbed patients, for whom trauma has impeded their psychosocial development. Introducing ideas from Bion and Lacan, such as “empty speech” and “attacks on linking,” she shows the reader their clinical utility. Her use of clinical moments, rather than more lengthy vignettes, invites readers to recognize that type of dilemma and imagine how they might use the concept in their own work.

Michael Eigen, Image, Sense, Infinities, and Everyday Life see book on Karnac

Comment on Karnac: Image and sensing have been underrated in Western thought but have come into their own since the Romantic movement and have always been valued by poets and mystics. Images come in all shapes and sizes and give expression to our felt sense of life. We say we are made in the image of God, yet God has no image. What kind of image do we mean? An impalpable image carrying impalpable sense? An ineffable sense permeates and takes us beyond the five senses, creating infinities within everyday life. Some people report experiencing colour and sound when they write or hear words. Sensing mediates the feel of life, often giving birth to image.In this compelling book, Michael Eigen leads us through an array of images and sensing in many dimensions of experience, beginning with a sense of being born all through life, psychosis, mystical moments, the body, the pregnancy of “no”, shame, his session with André Green, and his thoughts related to James Grotstein, Wilfred Bion, and Marion Milner. The author concludes with notes on his life as a young man leading him into the therapeutic vocation he has fostered and which has fostered him for nearly sixty years.

Stress Disorders from Infancy: The Two Trauma Mechanisms, Clancy Mckenzie, Clancy argues that schizophrenia is a delayed reaction on trauma’s in early childhood See book on amazon

Recommended articles

Karon, B. P. (2003). The tragedy of schizophrenia without psychotherapy. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 31, 89-118.f see Pdf

Charles, M. (2011). Working with Trauma: Lessons from Bion and Lacan. New Imago.

Pre-therapy and psychoanalysis article by Lisbeth Sommerbeck See Pdf

Hamm, J. A., & Lysaker, P. H. (2015, April 6). Psychoanalytic Phenomenology of Schizophrenia: Synthetic Metacognition as a Construct for Guiding Investigation., Psychoanalytic Psychology. See abstract

Recommended websites

Ann-Louise S. Silver’s website has her articles on the psychodynamic therapy of persons with psychotic disorders. www.mdpsychotherapy.com

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