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RONALD ABRAMSON, M.D.* Guidelines for the treatment of psychotic conditions currently emphasize psychopharmacology and supportive individual and family counseling as well as environmental approaches (American Psychiatric Association [APA], 1997). In the past three decades psychoanalytic therapeutic approaches to the treatment of these conditions have bccn regarded as ineffective, except in rare cases (Davis and Andriukaitis, 1986; Hogarty et al., 1986; Kane, 1987). The thrust of these guidelines is reflected by criteria that managed care organizations (MCOs) use to approve or disallow treatment services (Merit Behavioral Care, 1997). These criteria prescribe the use of medication combined with a psychotherapeutic approach that emphasizes brief treatment directed toward behaviorally measurable goals (United Behavioral Health, 1999). The uncovering of emotional life and the reconstruction of past experiences having emotional consequences in the present, characteristic of psychoanalysis and psychoanalytic therapy, are regarded as irrelevant in some cases and, in other cases, as disorganizing and therefore counter-therapeutic. Differences of opinion as to the relevance of psychoanalysis in the treatment of schizophrenia and related conditions goes back over 100 years. Freud (1911) did not attempt to treat primitive psychoses with psychoanalysis, and current biopsychiatry sees itself in the tradition of Kraeplin (1907), whose methods were
Journal of the American Academy of Psychoanalysis & Dynamic Psychiatry – Guilford Press
Published: Jun 1, 2001
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