A psychodynamic|psychoanalytic perspective to the understanding of psychotic and non-psychotic patients
Trained as psychiatrist, we are often intensely involved in descriptive psychiatry and symptomatology that we fail to see the suffering person behind the pathology. We encounter patients with a diagnosis of schizophrenia with dominant hallucinations and delusions who do not respond to the medical treatment. As a psychiatrists, we may become content with reducing the intensity of the symptoms. Yet, internally, we feel dissatisfied, we tend to shy away from this, to protect ourself from a lack of understanding of these patients.
We also encounter patients with no florid psychotic symptoms, yet we observe the therapeutic space to be suffering from a lack of thinking with overwhelming feelings of meaningless. A psychodynamic approach may lead us to a defensive psychotic organization protecting the personality from the fear of a catastrophe happening- a reference to patients with a diagnosis of borderline narcissistic personality disorder.
In addition we intend to point out some therapeutic spaces in the community and groups indicating the existences of psychotic parts in some apparently well-functioning people. The question may be asked: what is the experience of a schizophrenic patient? What goes on in his inner world?
We intend, through illustration of clinical cases, show some understanding of schizophrenic patient’s inner world by the therapeutic technique of transference and therapists’ counter transfers. We wish to raise the question of how psychiatry as a whole may help with an empathetic understanding of our patients.
Nasim Nekouei shoja
Psychiatrist & psychotherapy fellowship
Psychiatrist, psychodynamic psychotherapist