Benedetti (1992) noted the schizophrenic patient’s difficulty in distinguishing self from non-self. he schizophrenic person lives in the unbearable paradox of needing to differentiate oneself from the colonizing influence of others in the merger experience, yet, to separate would mean loss of the self. The loss of one’s own identity is always the basic danger. The abiding presence of severe annihilation and psychic-somatic death anxiety attests to this conundrum. Benedetti wisely notes that the patient’s nascent self exists in the projections set before us, i.e., the hallucinations and delusions. In regard to the latter, Benedetti concluded: “This negative kind of semiotics may be understood by us in the following way: the alienated Self, no longer having an unconscious image of its own identity, looks about in the surrounding world no longer for an image of the internal image -- in other words a symbol -- but for a substitute for it. This Self searches for something which refers continuously to itself, but does not lead back to itself because, sensorially speaking, it substitutes an absence. Without this external, hallucinatory substitute, the patient could not perceive himself; hence his resistance to abandoning it in a psychoanalysis which proposes to reduce it for him to a concept of Self. So our task is to look for the lost Self in the sensorial images which it sets before us, not by interpreting these images for him, but by enriching them with our presence to the point where we give them the consistency of new, positive symbols” (p.7).

In the psychotherapy of persons with schizophrenia, Benedetti (1987) stated “...the patient learns to distinguish between object and self, to sense his surroundings, and to organize his fragmented ego functions by means of the therapist’s allowing himself to be used as a symbiotic object” (p. 81). The role of interpretation in psychosis psychotherapy is different from the role of interpretation in the therapy of neurosis. Interpretations in the former address the structural needs of the person with schizophrenia: to help the patient discriminate self from non-self, to grasp the boundaries of the self, to achieve an intrapsychic coherence. Resistance to interpretations in psychosis psychotherapy involves an attempt at survival by means of organizing a psychotic identity in the vacuum of non-existence. Interpretations could not fill the terrible vacuum within patients with schizophrenia. Benedetti believed that these interpretations “...are aimed at putting ourselves into the psychotic world of the patient, then this psychotic world must become valuable to us as a message of a human longing for personal existence” (p. 86).

Benedetti (1987) emphasized that the role of interpretation in the psychotherapy of schizophrenia is different from its use in psychoanalysis. The schizophrenic patient is not just shown the “psychodynamic linings of the clothes of his illness,” but is also confronted with his potential image in ourselves and “the meaning his existence holds for our own.” Based on his over 50 years experience in the psychotherapeutic treatment of psychotic patients, Benedetti defined the turning point in therapy to occur when “the loss has been compensated for, not only by full participation in the patient’s situation but also by the introjection of this patient’s image, which allows him, conversely, to introject the therapist as a love object, as the Ego’s ideal, thus stimulating development of the Self” (p. 130. The loss Benedetti refers to is a loss causing a narcissistic gap deriving from loss of the ideal Ego. Benedetti defined the latter as “a superegoic image of the self needed by the Ego in order to unconsciously idealize itself, and thus fully accept itself” (p. 9).

Benedetti (1992) noted the schizophrenic patient’s difficulty in distinguishing self from non-self. The schizophrenic person lives in the unbearable paradox of needing to differentiate oneself from the colonizing influence of others in the merger experience, yet, to separate would mean loss of the self. The loss of one’s own identity is always the basic danger. The abiding presence of severe annihilation and psychic-somatic death anxiety attests to this conundrum. Benedetti wisely notes that the patient’s nascent self exists in the projections set before us, i.e., the hallucinations and delusions. In regard to the latter, Benedetti concluded: “This negative kind of semiotics may be understood by us in the following way: the alienated Self, no longer having an unconscious image of its own identity, looks about in the surrounding world no longer for an image of the internal image-in other words a symbol-but for a substitute for it. This Self searches for something which refers continuously to itself, but does not lead back to itself because, sensorially speaking, it substitutes an absence.

Without this external, hallucinatory substitute, the patient could not perceive himself; hence his resistance to abandoning it in a psychoanalysis which proposes to reduce it for him to a concept of Self. So our task is to look for the lost Self in the sensorial images which it sets before us, not by interpreting these images for him, but by enriching them with our presence to the point where we give them the consistency of new, positive symbols” (p.7).

In the psychotherapy of persons with schizophrenia, Benedetti (1987) stated “...the patient learns to distinguish between object and self, to sense his surroundings, and to organize his fragmented ego functions by means of the therapist’s allowing himself to be used as a symbiotic object.” (p. 81). The role of interpretation in psychosis psychotherapy is different from the role of interpretation in the therapy of neurosis. Interpretations in the former address the structural needs of the person with schizophrenia: to help the patient discriminate self from non-self, to grasp the boundaries of the self, to achieve an intrapsychic coherence. Resistance to interpretations in psychosis psychotherapy involves an attempt at survival by means of organizing a psychotic identity in the vacuum of non-existence. Interpretations could not fill the terrible vacuum within patients with schizophrenia.

Benedetti believed that these interpretations “...are aimed at putting ourselves into the psychotic world of the patient, then this psychotic world must become valuable to us as a message of a human longing for personal existence” (p. 86).

Benedetti (1987) emphasized that the role of interpretation in the psychotherapy of schizophrenia is different from its use in psychoanalysis. The schizophrenic patient is not just shown the “psychodynamic linings of the clothes of his illness,” but is also confronted with his potential image in ourselves and “the meaning his existence holds for our own.” Based on his over 50 years experience in the psychotherapeutic treatment of psychotic patients, Benedetti defined the turning point in therapy to occur when “the loss has been compensated for, not only by full participation in the patient’s situation but also by the introjection of this patient’s image, which allows him, conversely, to introject the therapist as a love object, as the Ego’s ideal, thus stimulating development of the Self” (p. 130. The loss Benedetti refers to is a loss causing a narcissistic gap deriving from loss of the ideal Ego. Benedetti defined the latter as “a superegoic image of the self needed by the Ego in order to unconsciously idealize itself, and thus fully accept itself” (p. 9).

References: Benedetti, G. (1987) Psychotherapy of Schizophrenia. New York: New York University Press.

Benedetti, G. (1992) The psychotherapy of psychotic and schizophrenic patients and factors facilitating this. In P. borri & R. Quartesan (eds) U.S.A.-Europe Conference on Facilitating the Climate for the Therapeutic Relation in Mental Health Services. Perugia, Italy: ARP.

Brian Koehler, Ph.D.
New York University
80 East 11th Street #339
New York NY 10003
212.533.5687
brian_koehler@psychoanalysis.net