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Furthermore, she was identified, I continued, with her own mother who she felt could not bear her. I interpreted further that her earlier rejection by her mother resulted in her mother’s becoming a persecutory internal demon who was now felt to be retaliating against her own foetus. The patient was silent for a moment and then uttered, ‘I’m looking at my baby, and now it has a mouth, eyes, and a nose. ’ And she cried. The following is a clinical excerpt from an analytic session with this patient: Adaptive context: (a) Autumn, with feelings from childhood about having to leave home and return to school; (b) daylight is beginning to diminish; (c) her teenage daughter (with whom she is very close) is going off to private school; (d) she is emotionally estranged from her husband, who Psychotherapy of schizophrenia and other psychoses 21 still lives with her; she is in graduate school and is seeking a higher degree but experiences difficulties in concentrating on her requisite dissertation.

Towards a Comprehensive Model for Schizophrenic Disorders. Hillsdale NJ: Analytic Press, pp. 29–74. Grotstein JS (1989) A revised psychoanalytic conception of schizophrenia: an interdisciplinary update. Journal of Psychoanalytic Psychology 6(3): 253–75. Grotstein JS (1990) The ‘black hole’ as the basic psychotic experience: some newer psychoanalytic and neuroscience perspectives on psychosis. Journal of the American Academy of Psychoanalysis 18(1): 29–46. Grotstein J (1997) The impact of neurodevelopmental findings on the psychoanalytic conception of schizophrenia: Toward the concept of rehabilitative psychoanalytic psychotherapy.

There are a number of important and relevant aspects of her past and current life that would be of interest in completing the picture, but space limitations require me to focus on only a few elements that emphasize my discussion. Because, allegedly, of the emotional distance between her and her mother, the patient was predisposed to anal masturbation to soothe her self as a child. She also recalls that from her earliest years a ‘bizarre object’ had haunted her. This ‘bizarre object’ took many forms but generally began as an image of a teddy bear or some other transitional object and then became de-animated and then throbbing and menacing.

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