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Selzer, M.A. (1991). Schizophrenia: Treatment Process and Outcome: By Thomas H. McGlashan & Christopher J. Keats. Washington, D.C.: Amer. Psychiat. Press, 1988, xix + 207 pp., $28.00.. J. Amer. Psychoanal. Assn., 39:274-277.

(1991). Journal of the American Psychoanalytic Association, 39:274-277

Schizophrenia: Treatment Process and Outcome: By Thomas H. McGlashan & Christopher J. Keats. Washington, D.C.: Amer. Psychiat. Press, 1988, xix + 207 pp., $28.00.

Review by:
Michael A. Selzer, M.D.

This is an important and exciting time in the history of the treatment of persons with schizophrenia. On the one hand, antipsychotic medication, though a powerful tool for ameliorating positive symptoms, has failed to produce a cure. On the other hand, empirical research into definitive psychodynamic treatment has yielded almost consistently negative results (Gunderson et al., 1984). One fact that cannot be ignored is that interpersonal strategies constitute a part of the treatment of every patient with schizophrenia. This being the case, it is important to investigate the patient-therapist dyad and, based on the data, devise strategies for improving the relationship. Schizophrenia: Treatment Process and Outcome addresses this issue directly by spelling out a methodology for studying the treatment process and then applying it to four patients treated at Chestnut Lodge twenty years ago.

The first half of the book is taken up with the four case histories, each narrative vividly and movingly confronting the reader with the vicissitudes of the schizophrenic illness. We are shown the impact of the illness on the patient's personality as well as of the patient's personality on the illness. We see the effect on family, friends, and those who aspire to be treaters. The reader becomes witness to the prolonged periods of defeat, the momentary victories, and the seemingly endless periods of stasis which the patient and those in contact with him share in unequal proportions. Each of the four chapters concludes with the report of a recent followup interview covering the patient's progress since discharge. Reading these four case reports, one cannot help but be moved by the plight of each of these individuals and the complexity of their lives. Though it is easy to anticipate even before the follow up information is presented, the two cases that will have a favorable outcome, it is equally clear that the "worst" cases show some areas of strength that the "best" cases lack, and that these four persons differ markedly from each other.

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