[The 3 phases of schizophrenic psychosis and their phase-specific psychotherapy]

It is not the diagnostic evaluation but merely the phase in which we find our patient, that determines about the process of psychotherapy with schizophrenic patients. There are three phases--or, more approximately, four phases (phase one to three plus "phase zero")--to be differentiated: Phase Zero: This phase precedes an obvious clinical appearance of psychosis. Patients feel ridiculous in their anxiety and are not yet capable to create the symptomatology of psychosis.--Intensive participation in those strange perceptions and the attempt to witness the same experiences as the patient does, often help to prevent the formation of a severe psychosis. Phase One: Deep psychosis with common symptomatology. Verbal communication in the usual form is no more possible. Only answering the patient in his own language--speaking as he speaks and behaving as he does--helps to overcome his permanent isolation. Phase Two: Stage where the patient leaves his psychotic world and does not yet live in the world of his "healthy" surroundings.--In this phase psychotherapy intends to lead towards a confrontation with the previous psychotic experiences in order to integrate them into his personality. Phase Three: Phase of return towards a more adequate behaviour.--In this phase the therapist helps his patient to build up his "narcissistic coat" in order to create a shelter, where he can retreat; out of this "cocoon" he is able to observe what happens around him, without being thrown back into a severe psychotic crisis. On the other hand there may arise situations of "relapses" (so-called intermediary stages). These phases, which resemble common depression, can be understood as substitutes of the former psychotic situation. It is insight in its uttermost distinction that leads to secondary stages. Therefore psychotherapy will be most helpful, when the understanding of the circumstances that lead to such situations, is not evaded but promoted; the more intensely these promotions, the better the prognosis.