Self Psychology and Psychosis: The Development of the Self During Intensive Psychotherapy of Schizophrenia and other Psychoses

Author(s) : David Garfield, Author(s) : Ira Steinman

Self Psychology and Psychosis: The Development of the Self During Intensive Psychotherapy of Schizophrenia and other Psychoses

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In this groundbreaking volume, David Garfield and Ira Steinman bring us into the immediacy of the analyst’s consulting room in direct confrontation with the thought disorder, delusions and hallucinations of their patients grappling with psychosis. From the early days of psychoanalysis when Freud explicated the famous Schreber case, analysts of all persuasions have brought a variety of theories to bear on the problem of schizophrenia and the other psychoses. Here, as William Butler Yeats notes, “the centre cannot hold” and any sense of self-esteem - positive feelings about oneself, a continuous sense of self in time and a functional coherence and cohesion of self - is shattered or stands in imminent danger.

What makes psychoanalytic self psychology so compelling as a framework for understanding psychosis is how it links together the early recognition of narcissistic impairment in these disorders to the “experience-near” focus which is the hallmark of self psychology. Now, with Garfield and Steinman’s descriptions of healing in the mirroring, idealizing and twinship experiences of treatment, the theory of self psychology, in a comprehensive fashion, is brought to bear on the psychoses for the very first time.

Join Garfield and Steinman as they bring the reader into these analytic journeys, inspired by Kohut and his followers and crafted with their own original insights as patients find their way back to a meaningful and functional existence.

Reviews and Endorsements

Read a review of this title in 'The Psychoanalytic Quarterly'

‘At the end of a very moving tale of the treatment of a psychotic woman, the patient tells the therapist, “You’ve given me my life.” The therapist, one of the authors of this book, replies, “Thanks. It’s been a gift to both of us.” So, too, one must thank the authors of Self Psychology and Psychosis for the gift given to readers of this volume that employs the theory of self psychology to guide and to better understand the psychotherapy of psychoses.’
— Arnold Goldberg, MD, Professor of Psychiatry, Rush Medical College; training and supervising analyst, the Chicago Institute for Psychoanalysis; author of The Brain, the Mind, and the Self: A Psychoanalytic Roadmap

‘This book should be fi rmly recommended to all teams of mental health professionals who come into contact with the more severely mentally ill, especially those who experience psychosis. Through a number of examples, the text demonstrates clearly how substantive numbers of those who are currently readily regarded as suffering from chronic disorders, especially schizophrenia, can in fact be helped to substantially recover and live satisfying lives through modern forms of skilled psychodynamic psychotherapy. The book focuses on the damage to the self and how this can be repaired in psychosis, especially using concepts from self psychology.’
— Dr Brian Martindale, Chair of the International Society for Psychological and Social Approaches to Psychosis

‘In an era of somatic and medication treatments, David Garfield and Ira Steinman have reminded us of the importance of listening to our patients with empathy and understanding, even those patients who are psychotic and disorganized. They remind us to see our patients as whole persons. Inside this volume, you will read how these experienced authors and clinicians empathize, query, interpret, and confront the whole patient. These skilled therapists demonstrate with captivating stories how, by making them feel understood, patients can make huge advances in their recovery and healing. I highly recommend Self Psychology and Psychosis.’
— Renée Binder, MD, Professor and Director, Psychiatry and Law Program, Associate Dean of Academic Affairs, School of Medicine, University of California San Francisco, President-Elect, American Psychiatric Association

‘David Garfield and Ira Steinman use a series of evocative and compelling case examples to illustrate how the principles of self psychology can be effectively applied in intensive psychotherapy with psychotic patients. Their fascinating and instructive presentation is an invaluable guide to productive clinical work with disturbed patients who too often are mistakenly judged to be beyond the reach of talking therapies.’
— Owen Renik, MD, former Editor, Psychoanalytic Quarterly; training and supervising analyst, San Francisco Psychoanalytic Center

‘As far as I am aware, there is no other book like this out there. No one else has so thoroughly described the psychological treatment of psychotic patients when concepts of self psychology are utilized to apprehend the therapist’s work and its efficacy. Of particular merit is the authors’ extensive description of clinical process, which vividly depicts how they struggled with the challenges they encountered in their work with these patients and how remarkably effective they were. The authors’ extensive clinical illustrations—often including verbatim dialogue—merit close attention.
—Howard Bacal, The Psychoanalytic Quarterly (2016)

About the Author(s)

David Garfield is Professor, Associate Chair for Psychotherapy and Director of Psychiatry Residency Training in the Department of Psychiatry and Behavioural Sciences at Rosalind Franklin University of Medicine and Science, Chicago Medical School. He graduated from UCSF School of Medicine and completed his psychiatry training at Harvard’s Massachusetts Mental Health Center. He also finished his psychoanalytic training in 2006 at Chicago’s Institute for Psychoanalysis and he is on their voluntary teaching faculty. He has written dozens of articles on psychotherapy and his book, Unbearable Affect: A Guide to the Psychotherapy of Psychosis is in its second edition (Karnac Books, 2009). He has co-edited the book Beyond Medication and he lectures internationally on psychosis.

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Ira Steinman has focused on schizophrenia for 45 years; his early training ranged from studying with R.D. Laing to working at the National Academy of Sciences' Drug Efficacy Study, which evaluated all the antipsychotic medications available at that time. For more than 35 years, he has pursued an out-patient psychiatric practice where he has been able to demonstrate that an intensive psychoanalytic psychotherapy, in conjunction with the judicious use of antipsychotic medication, can help even the most lost and disturbed schizophrenic and delusional patients recover, heal and, at times, achieve a cure. With such an approach, some allegedly ""untreatable"" schizophrenics have been able to work their way off of antipsychotic medication. He has spoken on this subject at length on a local, statewide, national and international level for more than twenty five years. He is a member of the ISPS (International Society for the Psychological Treatments of the Schizophrenias and other Psychoses); the American Psychiatric Association; and the Northern California Psychiatric Association

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