PSYCHOTHERAPY OF SCHIZOPHRENIA - USE OF T HE PATIENTS OWN SELF-HEALING TENDENCIES

Meaningful approaches in the field of psychotherapy of psychoses like Paul Federn's ego-psychology and Gunter Ammon's Dynamic Psychiatry did not lead to a systematic elaboration in clinical psychotherapy in our times. The author emphasizes the tendency to socially accepted compro mises in form of social psychiatric rehabilitation combined with commu nication groups for family members. New developmental tendencies show that we are now in a phase of change: the problem of psychosis has yet not been solved, but a space for succesful theapy has been opened. Po ssibilities of development are now to be seen in the nature of illness itself. The author understands psychoses as forms of modification of the self in the understanding of Kohut. That means, delusions are atte mpts to reestablish a holistic relationship towards reality. Delusions are wide spread phenomena which become a psychotic quality only by fi xation processes. During the process of illness an modified personalit y is reconstructed with a shortened reference to reality however. The author describes four forms of personality modification: elimination, i.e. the innerpsychic problem is separated and eliminated from the sel f, delusion fixation, which will be usually supported by the surroundi ng group like families, hospitals, etc., roll fixation, and embodiment as the most regressive form of modification, there exists no longer c ontact to the outer world. In modern days by using neuroleptic medicat ion, the acute crisis can be reduced to 3-5 days compared to the spont aneous illnes process in former times which. The author asks if it is really desireable that a quick stabilisation shall take place rather t han using this labile state for preparing compliance and rehabilitatio n? Social adaptation is far from realizing the need for therapy in the unstable phase of personality modification. Concluding, Schindler dis cusses three positions: 1. The assumption that the main process of ill ness coincides with the inpatient treatment is not true, the process o f illness is far more. 2. The assumption has to be proofed, if the sam e help is necessary during the acute state of psychosis and during the phase of the unstable process of personality modification. That means , it has to be proofed, whether neuroleptic medication is really helpf ul during the process of modification. Medication supports delusion fi xation and roll fixation. Possible creative aspects as shown in dreams are not integrated, dreams dry up. Such a kind of early stabilisation stops changes. 3. A psychodynamic understanding of psychosis leeds to a new assessment of the productive illness relapse in the sense of a conctructive modification of the self-object-representative. The autho r emphasizes a new understanding of psychiatry as a therapy aware unde rstanding of risk which means that nowadays we have more therapeutic s trategies than 100 years ago. He stresses the use of analytic psychoth erapy in psychiatry, the use of dreams and emancipation out of resigne d limitations with the risk of a possible delay in favour of more qual ity of life. If the therapist takes more risk and responsibility to cr eate more possibilities of development in the frame of open lability, it will be possible to set up true psychodynamically leaded wards and modells of a new form of therapy.