ABSTRACT
This chapter begins by explaining some basic psychoanalytic terms. Psychoanalysis often uses the term “psychosis” in a different way to the usual use of the term. The chapter then describes the role of the concept of psychosis in the development of Kleinian thought. The paranoid-schizoid position underlies many non-psychotic psychological problems in this Kleinian model. However, some analysts have worked with psychotic or “schizophrenic” clients. Norman Cameron’s paper on the paranoid pseudo-community explains the onset of a psychosis in these terms. Psychosis is seen as a withdrawal from interpersonal relationships to a more primitive mental state in which the person relates to figments of their imagination or unconscious. The chapter gives a detailed description of two models of psychosis; the theories of Laing and Bollas. Both of these psychoanalysts worked with clients with schizophrenia. Laing describes how psychosis can arise from a non-psychotic schizoid state and Bollas describes the process of withdrawal into a different state of consciousness. All these writers see this regression as a motivated act of defence. Bollas’ suggested modifications to psychoanalytic technique are noted. It is suggested that these modifications to technique could be usefully included in a CBT treatment to make the therapy more comprehensive. An eclectic therapy is the most empirical approach to work with psychosis.
