The successful psychoanalytic therapy of a schizophrenic woman.

The prevalent sociocultural belief about the psychoses and schizophrenia is that intensive psychoanalytic therapy is ineffective if not destructive and contraindicated, and that the treatment of choice is a combination of psychopharmacology and educational techniques designed to provide symptom relief and rehabilitation. The literature contains few detailed reports of successful intensive psychotherapy that might contradict these beliefs. The psychoanalytic psychotherapy of a woman I shall call Sara, who met DSM criteria for chronic paranoid schizophrenia, is presented in detail. Its success in bringing about a fundamental personality transformation from a seriously self-destructive state in which she was unable to care for herself to one in which she became a mature creative person is confirmed by a follow up two decades after termination. The therapy transpired over an 11-year period and was conducted for the most part four times per week. It was supported by numerous hospitalizations in the early years as well as pharmacotherapy which she was able to relinquish prior to termination. During treatment Sara separated both physically and psychologically from an undifferentiated destructive relationship with her mother, internalized the capacity to think and represent emotions, and integrated disparate elements of personality to form a cohesive self. She developed psychosexually and formed a mature gender identity. She achieved the capacity for intimacy and motherhood, and had a successful career.