Psychotherapy of Preoedipal Conditions: Schizophrenia and Severe Character Disorders

398 Pages·1995·20.642 MB·English

by  Hyman Spotnitz

PSYCHOTHERAPY OF
PREOEDIPAL CONDITIONS

PSYCHOTHERAPY OF
PREOEDIPAL CONDITIONS
Schizophrenia and Severe
Character Disorders
by
Hyman Spotnitz, M.D., Med. Sc.D.
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Lanham • Boulder • New York • Toronto • Oxford
THE MASTER WORK SERIES
A JASON ARONSON BOOK
ROWMAN & LITTLEFIELD PUBLISHERS, INC.
Published in the United States of America
by Rowman & Littlefield Publishers, Inc.
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Copyright@ 1987, 1976 by Jason Aronson Inc.
First softcover edition 1995
First Rowman & Littlefield Edition 2004
All rights reserved. No part of this publication may be reproduced,
stored in a retrieval system, or transmitted in any form or by any
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without the prior permission of the publisher.
British Library Cataloguing in Publication Information Available
Library of Congress Cataloging-in-Publication Data
ISBN 1-56821-633-5 (paper)
ISBN: 978-1-56821-633-1
Library of Congress Catalog Card Number: 75-37489
Printed in the United States of America
9"'
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Materials, ANSIINISO Z39.48-1992.
Preface
This book spans more than a quarter of a century. Its contents blend pa
pers that are now out of print and currently in demand with previously un
published lectures or othe~ oral presentations and some of my most recent
contributions to multi-authored books on issues in contemporary practice.
All of the material has been reedited, some of the early reports have been
extensively revised, and the book has been organized to reflect the evolu
tion of contemporary individual and group approaches to patients w~th
severe but psychologically reversible problems originating in the preoedipal
phase of development. These include psychosomatic conditions, psychotic
states, and character and behavior disorders that can be traced back to psy
chological disturbances during the first two years of life.
The book focuses on two subjects with which I have been preoccupied
since I began the private practice of psychoanalytic therapy in 1939. One is
the treatment of schizophrenia and other preoedipal disorders; the other,
analytic group psychotherapy, as applied for the same purpose. I was
drawn into the latter area during the 1940s as consulting psychiatrist to the
treatment agency where S. R. Slavson and his associates were intent on the
systematic development of group procedures.
The book is intended for psychiatrists, psychologists, psychiatric social
workers, and members of the other behavioral sciences, or those preparing
to enter these fields, who are interested in achieving significant results in the
treatment of severe forms of emotional illness. Understanding of the many
forces that serve to create the mature personality is essential in this difficult
work; but this needs to be combined with knowledge of therapeutics if one
6 PREFACE
wants to help individuals with crippling preoedipal problems achieve their
potential in life.
When students enter supervision,. their main interest is usually in filling
the requirements for carrying on the practice of psychoanalytic therapy.
Operating under the pressure for accreditation, they tend to forget what
they learn. If they return to supervision later, they generally demonstrate
more serious concern about treating patients more effectively.
It has been my privilege to carry on a second round of supervision for stu
dents and colleagues already trained in classical psychoanalysis who solicit
further guidance in their work with schizophrenic and other preoedipal pa
tients. These supervisees, like practitioners who consult me when problems
arise in their management of such patients, have shown much interest in
tracing the evolution of the modern methods of treating them. Knowledge
of the various stages in the development of the approaches I recommend has
not only increased their security and comfort in working with these pa
tients; it has also stimulated new and original contributions in the spirit of
these approaches.
In making the same knowledge available through this book, I hope to
open up new perspectives in the treatment of the preoedipal disorders and
to facilitate more consistently effective results in these cases.
Six of the papers in this book were collaborative works, as indicated in
the text. They are reprinted here with the permission of Mrs. Yonata Feld
Leo
man, M.S. W., Mrs. Betty Gabriel, Philip Resnikoff, and the estate of
Nagelberg, Ph.D.
I am pleased to acknowledge the cooperation of Julia Older Bazer in the
presentation of the book. Her assistance encompassed the organization and
editing of its contents and the revision of some of the chapters.
HYMAN SPOTNITZ
Acknowledgments
For permission to reprint material to which they hold copyright, grateful
acknowledgment is made to the following sources:
Introduction: "My Philosophy of Psychotherapy." JOURNAL OF CON
TEMPORARY PSYCHOTHERAPY, 1973 (6:43-48). Copyright, the Long
Island Consultation Center, Forest Hills, N.Y.
Chapter 2: Discussion of "Irrational Trends in Contemporary Psycho
therapy" (E. K. Schwartz and A. Wolf). PSYCHOANALYSIS AND THE
PSYCHOANALYTIC REVIEW, 1958 (45 (1-2): 74-78). Chapters 2, 4, and 9
reproduced by courtesy of the Editors and the Publisher, National Psychol
ogical Association for Psychoanalysis, New York, N.Y.
Chapter 3: "Strengthening the Ego through the Release of Frustration
Aggression." AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 1958
(28:794-801). Chapters 3, 15, and 16; Copyright, the American Orthopsy
chiatric Association. Reproduced by permission.
Chapter 4: ''The Maturational Interpretation." THE PSYCHOANALYT
IC REVIEW, 1966 (53:490-495).
Chapter 5: ':The Toxoid Response." REPORTS IN MEDICAL AND
CLINICAL PSYCHOLOGY, Monograph No. 3, 1963. Chapters 5, 10, and
11: Copyright, Psychology Department, Stuyvesant Polyclinic, New York,
N.Y.
Chapter 6: "A Psychoanalytic View of Resistance in Groups." THE
INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 1952
(2:3-9). Chapters 6, 21, 22, 23, 27, 28, 29, and 30: Copyright, American
Group Psychotherapy Association, Inc.
8 ACKNOWLEDGMENTS
Chapter 7: "Psychoanalytic Therapy of Aggression in Groups." CUR
RENT PSYCHIATRIC THERAPIES, 1968, Volume 8, edited by J. Masser
man. Copyright, Grune & Stratton, Publishers, New York, N.Y.
Chapter 8: "The Management and Mastery of Resistance in Group Psy
chotherapy". THE JOURNAL OF GROUP PSYCHOANALYSIS AND
GROUP PROCESS (now GROUP PROCESS), 1968 (1(2] :5-23).
Chapter 9: "The Myths of Narcissus." THE PSYCHOANALYTIC RE-
VIEW, 1954(41:173-181). ,
Chapter 10: "The Narcissistic Defense .in Schizophrenia." REPORTS IN
MEDICAL AND CLINICAL PSYCHOLOGY, Monograph No. 1, 1961.
Chapter 11: "The Need for Insulation in the Schizophrenic Personality."
REPORTS IN MEDICAL AND CLINICAL PSYCHOLOGY, Monograph
No.3, 1963.
Chapter 12: "Techniques for the Resolution of the Narcissistic Defense."
PSYCHOANALYTIC TECHNIQUES: A Handbook for the Practicing Psy
choanalyst, edited by B. B. Wolman. (C) 1967 by Basic Books, Inc. Publish
ers, New York.
Chapter 13: "Group Psychotherapy with Schizophrenics." GROUP
PROCESS TODAY: Evaluation and Perspective, edited by D. S. Milman
and G. D. Goldman, 1974. Charles C Thomas, Publisher, Springfield, Ill.
Chapter 14: "Initial Steps in the Analytic Therapy of Schizophrenia in
Children." THE QUARTERLY JOURNAL OF CHILD BEHAVIOR, 1952
(4 :57-65). Chapters 14 and 20, Copyright, Jelliffe Trust.
Chapter 15: "The Attempt at Healthy Insulation in the Withdrawn
Child." AMERICAN JOURNAL OF ORTHOPSYCHIATRY, 1953 (23: 238-
251).
Chapter 16: "Ego Reinforcement in the Schizophrenic Child." AMERI
CAN JOURNAL OF ORTHOPSYCHIATRY, 1956 (26: 146-162).
Chapter 17: "Adolescence and Schizophrenia: Problems in Differentia
tion." ADOLESCENTS; Psychoanalytic Approach to Problems and
Therapy, edited by S. Lorand and H. I. Schneer, 1961. Copyright, Medical
Department, Harper & Row, Publishers, Inc., Hagerstown, Maryland.
Chapter 18: "Object-Oriented Approaches to Severely Disturbed Adoles
cents." THE ADOLESCENT IN GROUP AND FAMILY THERAPY, edited
by M. Sugar, 1975. Brunner/Mazel, Publishers, New York, N.Y.
Chapter 19: "Observations on Emotional Currents in Interview Group
Therapy with Adolescent Girls." JOURNAL OF NERVOUS AND
MENTAL DISEASE, 1947 (105: 565-577). Copyright, Jelliffe Trust.
Chapter 20. "Resistance in Analytic Group Therapy: A Study of the
Group Therapeutic Process in Children and Mothers." THE QUARTERLY
JOURNAL OF CHILD BEHAVIOR, 1950 (2: 71-85).
Acknowledgments 9
Chapter 21: "The Borderline Schizophrenic in Group Psychotherapy."
THE INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY,
1957 (7:155-174).
Chapter 22: "The Concept of Goals in GrC?UP Psychotherapy." THE
INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 1960
(10: 383-393).
Chapter 23: ''Touch Countertransference in Group Psychotherapy."
THE INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY,
1972 (22:455-463).
Chapter 24: "Acting Out in Group Psychotherapy." GROUP THERAPY
1973: An Overview, edited by L. R. Wolberg and E. I<. Schwartz, 1973.
Copyright, Intercontinental Medical Book Corporation, New York, N.Y.
Chapter 25. "Group Therapy in Perspective." THE AMERICAN
JOURNAL OF PSYCHIATRY, 1972 (129:606-607). Copyright 1972, the
American Psychiatric Association.
Chapter 27: Book Review, A Psychotherapy of Schizophrenia: Direct
Analysis (A. E. Scheflen). THE INTERNATIONAL JOURNAL OF GROUP
PSYCHOTHERAPY, 1962 (12:267-269).
Chapter 28: Discussion of "Accelerated Interaction: A Time-Umited
Approach" (F. H. Stoller). THE INTERNATIONAL JOURNAL OF
GROUP PSYCHOTHERAPY, 1968 (18: 236-239).
Chapter 29: "Resistance Reinforcement in Affect Training of Analytic
Group Psychotherapists." THE INTERNATIONAL JOURNAL OF GROUP
PSYCHOTHERAPY, 1958 (8:395-402).
Chapter 30: Discussion of "Harassed! A Dialogue" (L. S. Brody). THE
INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 1966
(16:491-494).