Patient-therapist-matching in outpatient psychotherapy with psychotic patients

In an outpatient setting the matching of patient and psychotherapist is ess ential as there is - in most cases - no protecting institutional frame. Bec ause of the disturbance in his symbolic function the psychotic patient tend s to act out his basic conflict between self- and object-related tendencies . As the patient strives for differentiation and separation, naturally, str uggle is involved on various levels. The therapist must feel up to all aspe cts of this struggle including the more concrete ones. Also psychotic patie nts always induce an intricate interplay of narcissistic transference and c ountertransference. The psychotherapist should have the capacity to gain di stance from his narcissistic countertransference, which as a rule should fi nd support through supervision. It is necessary that in the patient there e xist remnants of relatedness to his fellow-men and also a minimum amount of ego-strength and structure that enables him to cope with a cycle of more o r less periodical appointments.