Changes in object relations in psychotherapy with schizophrenic patients: Commentary on Carsky and Rand (2018).

In this discussion of Carsky and Rand (2018), I respond to Ms. B’s moving depiction of her struggles to emerge from, control, and understand a chronic psychotic disorder while at the same time struggling to go on with her own educational and psychosocial development. Her moving account brings up two major issues in treating psychotic patients. First, as Bion (1957) has said, there is a psychotic and nonpsychotic aspect to the personality, and the therapist who works with psychotic patients must not only treat both dimensions or sectors, but also keep them both in mind as crucial aspects of the patient’s mental life, if treatment is to be successful. Second, the internal world of mental representations of psychotic patients cannot be understood solely in terms of their psychotic illness, although of course it is influenced by it. Nonetheless, the world of mental representations may develop and change in tandem with or separately from the vicissitudes of the psychotic disorder. In this discussion I focus on the way that Dr. A worked with both the psychotic and nonpsychotic part of Ms. B’s personality, throughout the treatment. Second, I will focus on how she addressed the object relational distortions and conflicts with which Ms. B presented, particularly as they were externalized in the transference. (PsycINFO Database Record (c) 2018 APA, all rights reserved)