Psychodynamic treatment of schizophrenia: is there a future?

The psychoanalytic treatment of schizophrenia has had a long and controversial history. Freud and his more orthodox followers felt that schizophrenics were not suitable for psychoanalysis. However, a long list of dissenters have enthusiastically advocated this treatment (e.g. Rosen, 1947; FrommReichmann, 1950; Will, 1958; Searles, 1965; Pao, 1979). For decades the dominant treatment model, the efficacy of psychoanalytic and psychodynamic interventions for schizophrenia has recently been questioned (May, 1968, 1984). Despite some decline in popularity, psychodynamic therapy continues to be an important individual treatment modality for schizophrenics. Psychodynamic treatment is usually provided in combination with pharmacotherapy (Feinsilver, 1983; Normand & Bluestone, 1986) for schizophrenics in both in-patient and out-patient settings (e.g. Karon & Vandenbos, 1982; Stone et al. 1983; Frosch, J983; Auerhahn & Moskowitz, 1984; Spotnitz, 1985; Silverman & Lachmann, 1985; Feinsilver, 1986; Kernberg, 1986; Lassers, 1986; Mann, 1986; Benedetti, 1987; Munich, 1987; Strean, 1988). To examine whether there have been changes in the general scholarly and clinical interest in the psychodynamic treatment of schizophrenia, we conducted a review of the literature published in journals over the past twenty-one years. Using the Medline (National Library of Medicine, 1987) and PsychlNFO (American Psychological Association, 1988) data bases, we identified articles using the index terms or title words 'schizophrenia', 'psychodynamic', or 'psychoanalysis'. A total of 478 articles were located, of which 159 (33 %) described actual schizophrenic patients who had been treated according to this approach. (Duplicate articles describing the treatment of the same patients were counted only once.) Fig. 1 contains a plot of the number of psychodynamically-orientated treatment articles on schizophrenia and the total number of articles on psychodynamic theory and schizophrenia from 1966 through 1987. Inspection of the figure suggests a recent decline in the