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Psychoanalytic psychotherapy of psychosis

According to the psychoanalytic theory, psychosis consists in the disruption of the patient's relationship with the world of objects and subsequently in his attempt to re-organize this defective relationship capacity. Mechanisms involved are regression to a narcissistic objectless state, while at the same time, mainly through projection, the individual tries to restore the chaos he feels intrapsychically. A concept proposed by certain psychoanalysts is the concept of neutralization of the instinctual energy of the sexual and the aggressive drives. Neutralization provides the ego with energy which can be utilized for the development of ego and superego functions. When an individual becomes psychotic this energy becomes de-neutralized, disrupting ego and superego functions, such as reality testing, object relationships, thinking, affect, capacity for attention etc. Emphasis has been given to the importance of the mother-child relationship early in life for the development of a strong ego serving good adjustment through the various stages of development. When various pathological conditions lead to a defective ego, the individual is in a vulnerable position to manifest psychotic symptoms, especially when a genetic predisposition is present. Psychoanalytic psychotherapy of psychosis is a very difficult and time-consuming process. Its goal is to correct as much as possible the defective ego of the patient Interpretations are useful in helping the patient understand and gain control over his symptomatology, but what remains of central importance is the therapist-patient relationship in which the therapist functions as an auxiliary ego and as benevolent care-taker.

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Berati, S. Psychoanalytic psychotherapy of psychosis. Ann Gen Hosp Psychiatry 2 (Suppl 1), S52 (2003).

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