ABSTRACT
The local International Symposium of the Psychotherapy of Schizophrenia group had a example of the lack of fantasy and play when the late Elaine Schwager presented a case of an autistic child. For analytic treatment, Salman Akhtar emphasizes six tasks: providing and sustaining a meaningful 'holding environment'; affirmative interventions; and helping the patient unmask these fantasies and interpreting their defensive, narcissistic and sadomasochistic aspects. These also include rupturing the patient's excessive hope, analyzing the effects of such rupture, and facilitating the resultant mourning; reconstructing the early scenarios underlying the need for excessive hope; and paying careful attention to countertransference feelings through such work. Akhtar abstract covers his thinking quite well: Fantasies whose core is constituted by the notions of "someday" and "if only" are ubiquitous in the human psyche. In severe character pathology, however, these fantasies have a particularly tenacious, defensive and ego-depleting quality.
