Treatment alliance and the chronic schizophrenic

When something in common can be found to establish relatedness; when therapists can trust that the patients will eventually be able to contain their destructiveness and that on some level they struggle with their pathology, then patients begin to identify with their therapists and with those aspects within themselves. This activity requires that first a climate of safety, based on a frame, be established. Once it is established, the search for the common "thing"--the organizing object--and the ability to work with it can go on with far less distraction. Along the way, therapists insist that words can be used to convey meaning, creating the climate for eventual interpretation. In the case described, the therapist made it clear that he disagreed with the patient's delusional viewpoint, but at the same time was interested in hearing the material as a source of ideas about how the patient experienced her world, and how to discover what remained of her capacity for self observation and nonpsychotic thought. The therapist's acceptance of the need for such a preliminary phase may make it possible for severely resistant patients to become engaged with those treating them.