Psychotherapy of psychoses: some principles for practice in the real world

Treatment of psychoses must include psychological treatments for the mind joined with the commonly employed biological treatments for the brain. There are various schools of psychotherapy, but psychoanalytic treatment is the only Western discipline devoted to comprehensive understanding of the subjective mind. Psychoanalytic authorities have written extensively on the psychodynamics involved in treatment of psychoses, but such approaches are limited by the realities of limited resources and number of therapists who have advanced training. Also, the techniques and understandings developed by prominent authors cannot always be implemented by many therapists who do not enjoy as robust a theoretic background. Presented here are five principles that are useful to keep in mind during the treatment of people with psychotic problems. These principles are: safety in the therapeutic situation, empathy as a means of understanding the patient and avoiding countertransference problems, validation in the therapeutic situation as enhancing safety and promoting ego strength in a fragile ego, being a "real person" with the patient rather than a taciturn traditional psychoanalytic "mirror", and "transmuting internalization" as the way in which the therapeutic process promotes the development of a stronger self able to live in conventional reality. These principles are easy to keep in mind and are compatible with cognitive and behavioral techniques as well as other psychoanalytic theories and approaches.