Intensive psychotherapy of psychosis in a decade of change

The past decade has brought extraordinarily rapid changes to the treatment of patients with severe mental illnesses. Changes evolved from advances in technologic and pharmacologic understanding as well as from complex fiscal and political pressures. Increasingly, regimented standardization in approach narrows the range of treatment options. Both within and outside of psychiatry, some disparage psychodynamic approaches. Psychiatrists are required to accept as plausible standardized and constricted time frames for evaluation and treatment. Thus we are asked to view the mind's storms as strictly neuronally based and to view our patients as passively compliant. By implication, treatment alliance is to be cemented by a prescription and authority. This paper presents clinical material drawn from hospital-based experience at The Chestnut Lodge Hospital, Rockville, Maryland, meant to place current trends in an historic context. The author offers possible alternatives to resignation in the face of current pressures.