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Impasse Resolution with the Schizophrenic Patient

ARNOLD J. MANDELL, M.D.
Arch Gen Psychiatry. 1963;8(5):486-496. doi:10.1001/archpsyc.1963.01720110062008.
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This paper will constitute an attempt to evolve a particular kind of relationship between some psychotherapeutic theories and psychotherapeutic practices with the schizophrenic patient. The focus will be on one aspect of the process: an induced shift in the ongoing interpersonal transactional mode in order to resolve an impasse. Case material will be presented exemplifying the use of this technique under widely varying circumstances.

I. Theoretical Considerations  Freud tended not to work with obviously psychotic patients. He offered the rationale that psychoanalytic techniques were of little value, stating that the patient was unable to form a transference. He felt that this was characteristic of the "narcissistic neuroses." Using the Schreber case and others as examples, he concluded that internal objects were destroyed in the psychotic process, and all object libido was thus focused on the self, making the transference neurosis unlikely to occur.1,2

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