BREVE SINOSSI The guiding question can be summarized as follows: Do psychotic disorders make sense? Are psychotic symptoms amenable to interpretation? In the book, the contributions made by psychoanalytic authors to do justice to a person having fallen ill with psychotic disorders and to take him or her seriously, are presented. But the book does not confine itself to a historical overview. Using the contributions as elements, it rearranges them into a factor model that allows to systematically assess the relevant psychodynamic dimensions in the diagnosis of psychotic disorders and, second, to serve as a guide to psychoanalytic psychotherapy with psychotically ill patients.

For more than a century, psychoanalysis has contributed widely to an understanding of psychotic experience and dynamics. Freud revealed the (re) constructive properties inherent in delusional thinking. He also initiated research on formal disturbances seen in acute psychosis by attributing meaning to them (e.g. by stating that the over-cathexis of words is due to the endeavour to find a way back to the object.). Many a psychoanalyst after Freud dedicated himself or herself to the psychoanalytic treatment of psychotically ill patients. The clinical encounter opened the way to new insights. M. Klein was able to show that psychotic experiences are not alien to psychiatrically healthy persons but are part of normal psychic life by describing a paranoid-schizoid position as a general mode of thinking. W.R. Bion was the first to outline a theory of thinking that allows to assess in how far psychic representations can be processed intrapsychically, at what stage they cannot be contained in the individual psyche, when uncontrollable aggression leads to disrupture of representational links etc. J .Lacan highlighted the role a specific mechanism of defence, foreclosure, in the beginning of a psychotic crisis. Thanks to the subtle clinical descriptions presented by G. Benedetti, the role of the analyst in the psychotherapeutic encounter with psychotic persons could be elucidated. More authors are highlighted in the book, together with their pivotal concepts. 

But the history of psychoanalytic theories on psychosis is not an end in itself. The various concepts can be used as elements that can be integrated in an integrative structure or a factor model by which to attain a multi-dimensional approach to psychotic experience and to the aims of psychoanalytic psychotherapy with psychotic patients. 

The therapist is bound to have a clue how the dynamics in psychosis work whenever he or she engages in the challenging task to provide psychoanalytic psychotherapy for the psychotic patient. Some aspects are worth to emphasise:

• Really understanding the psychotic crisis is possible only when therapist and patient reach an insight into the precursor states or the inner and outer circumstances prior to a psychotic crisis.
• Psychoanalytic treatment can be useful even in dealing with so called negative states or symptoms because it can help to elucidate semiotic qualities in a seemingly void atmosphere or in thinking disorders. What at first sight appears to be a defect might eventually turn out to be the result of “the work of the negative”. So, psychoanalytic psychotherapy allows to redefine negativity as a form of self-conservation, e.g. by erecting a barrier of void between self and object to shelter the endangered self from object intrusion.
• A psychotic state is never all-encompassing. The personality might be split between a psychotic and a non-psychotic part of the personality. Each of the parts can be used to mask the other thus rendering the task for the therapist to communicate with all aspects of the patient’s personality difficult. 
• Psychopharmacological treatment in patients with psychotic crises might be valuable or even mandatory. It is only by the psychoanalytic reflection on the changes in transference and countertransference that the interpersonal consequences of drug treatment can be assessed. Likewise, it needs psychodynamic reasoning to decide when drugs are productive or counter-productive in the treatment process.

Osservazioni conclusive
Throughout the text, and especially in the part dealing with psychoanalytic psychotherapy, clinical vignettes illustrate the theoretical account and give clues as to how the concepts can be used in clinical practice. 

On top of the vignettes, three case reports present therapies or analytic interpretations in more details. Two of them are drawn from long term psychoanalytic psychotherapies, the third takes a novel as its material, namely “Bartleby the scrivener” written by Herman Melville.


AREA OF CLINICAL STUDY: Teoria


EDITORE Routledge


ANNO PUBBLICATO 2018


AUTHOR IPA SOCIETY: German, Swiss


AUTORE BIO Joachim Küchenhoff, MD, is a psychoanalyst (IPA, Swiss and German societies). He is a specialist in psychiatry, psychotherapy and psychosomatic medicine, Professor emeritus of Psychiatry and Psychotherapy at the University of Basel, Switzerland, and visiting Professor at IPU (International Psychoanalytic University) Berlin; he is president of the supervisory board at IPU and member of many other advisory boards. He is author and editor of many publications (www. praxis-kuechenhoff.ch).