ABSTRACT
Psychotherapy with a psychotic patient may need to go on for a long time if the patient is to be able to live independently without the help of the therapist. The therapist is in the position of having to decide whether to reopen the matter of termination of therapy and deal with the consequences, for better or for worse. The urge for reparation may become very powerful in some patients who have reached the depressive position, and this may help explain why patients like Florence hold on so tenaciously to their therapy and therapist if this dynamic is not recognized and worked through. Perhaps the decline in the use of the diagnosis “hysteria” is a consequence of the wider recognition of the difficulty in differentiating severe “hysterical” disorders from schizophrenia, and of the decline in the belief that such a condition is in some way less severe than “genuine” schizophrenia.
