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Rosenfeld, H. (1969). On the Treatment of Psychotic States by Psychoanalysis: An Historical Approach. Int. J. Psycho-Anal., 50:615-631.

(1969). International Journal of Psycho-Analysis, 50:615-631

On the Treatment of Psychotic States by Psychoanalysis: An Historical Approach

Herbert Rosenfeld

During the last 50 years the psychoanalytic approach to psychosis has undergone very considerable change and at the present time there is no unified theory of either the psychopathology or the technique of treating the psychoses. Many analysts working with psychotics have found it necessary to alter to some extent the classical technique of analysis developed by Freud in dealing with neurotic states; a technique which relies predominantly on the development of transference manifestations which can be interpreted to the patients. Freud himself thought, as I shall show later, that this technique was unsuitable for psychotics. The work of many analysts has been influenced by Freud's belief that psychotics do not develop a transference. However, an increasing number of analysts have tried to develop methods with the hope that eventually some contact with the psychotic, and with this some improvement of the psychotic condition, might be achieved.

In discussing the motives of analysts, such as Rank, who have branched off from psychoanalysis, Freud (1933) felt that

responsibility must be laid on the intimate relations which exist in psychoanalysis between theoretical views and therapeutic treatment.

The changes in the therapeutic approach to psychotics are certainly influenced by the theoretical views held by the therapist and by factors in the therapist's own personality.

A clearly defined method of approaching psychotic states is important if we expect to do research to clarify the psychotic psychopathology rather than concentrating on symptomatic improvement.

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