[Role of psychotherapy in the treatment of schizophrenia]

Reality-adaptative, supportive psychotherapy, institutional cares, therapeutics with artistic mediations, family therapeutics are unanimously recognized as efficacious therapeutics for schizophrenic inpatients and outpatients. Conversely, the usefulness of psychoanalysis and exploratory, insight-oriented psychotherapy is questionnable. To clear up the question, we have studied controlled and non controlled studies comparing different psychotherapies, as well as the results of individual psychoanalysis. Among the controlled studies, Stanton's study stands out for its methological strictness. This study, in 164 schizophrenics, shows that insight-oriented psychotherapy is not more efficacious than supportive psychotherapy. In the continuation of this work, A. Frank and J. Gunderson show that the determinant factor of the psychotherapy's result is relational continuity and especially therapeutic alliance. Some works made in France show that 6 to 8 months are needed to appreciate the efficacy of institutional cares and psychotherapies can be observed. The psychoanalysis is not always efficacious. But these long acting experiences have provided irreplaceable knowledge towards the understanding of schizophrenic self and transference, effects of institutional cares, therapeutics with artistic mediations, supportive psychotherapy, theoretical reflection (Racamier, Rosenfeld, Searles, etc). Among the metapsychological knowledge, we must see: alterity's denial, struggle against thinking's activity, erotically paradoxical transference, receptacle's and depositary's function of therapists, inexistence of containing function. These knowledges explain that the two principal functions of the care given to schizophrenics are: help to self and presence.