ABSTRACT
Analysis of transference in relation to childhood history is as important in the therapy of psychotic as it is with neurotic individuals. Some of the complexities of transferences formed between the patient’s primordial conscious undifferentiated and unintegrated psychosomatic mentation and the therapist’s reflective representational thought are outlined. In order to understand the transference the patient must be helped to translate the manifestations of primordial conscious mentation into reflective representational thought. The object of therapy is to translate an unintegrated undifferentiated mind into a mind capable of experiencing and resolving intrapsychic conflict and making constructive decisions.
The role of the remembered and reconstructed past in treatment of neurotic and psychotic individuals is discussed. Neurotic individuals are capable of constant mental representation and reflection, so that allowing for irreducible subjectivity they are able to remember, and to recall repressed memories. Psychotic persons whose primordial conscious mentation is somatic, enactive, and ideational do not usually have an emotionally based remembered past and live in a non-temporal world in which the present is reacted to as though it were the unremembered and unthought past. In order to reconstruct a plausible past that helps them to be aware of, understand, and empathize with the reasons for their behavior in the present, they require help translating transference enactments from the language of primordial consciousness into reflective representational thought.
Some of the regression-fostering problems of standard technique are discussed, such as the patient being in a position out of eye contact with the analyst and free association encouraging lack of integration, as well as those resulting from making interpretations to a person functioning in primordial mentation in the language of representational thought.
Stages of therapy with persons whose psychoses differ in severity depending on the level of separation–individuation at which they emerged are outlined, from engagement through the unique problems encountered identifying and analyzing transference. Freud was not entirely wrong in believing that schizophrenic persons are unable to form a working relationship with the analyst. There are two solipsistic stages in the treatment of schizophrenia and one in the treatment of persons with psychotic personalities. The mental hospital has a unique holding role in the engagement process with schizophrenic persons. Some of the unique problems encountered in engaging schizophrenic persons and psychotic personalities are described.
