04 Nov 2013

Seminar on Intrattabili at Centro di Psicoanalisi in , Rome

On Saturday, October 5th, San Francisco psychiatrist Ira Steinman, MD , author of the Karnac book TREATING the ‘UNTREATABLE’: Healing in the Realms of Madness , gave a spirited seminar on the curative intensive psychotherapy of people with a diagnosis of psychosis at the Centro di Psicoanalisi in , Rome. The seminar was called Intrattabili and dealt with the usefulness of an in-depth psychotherapeutic approach in patients across the psychotic spectrum. The presentation included a disorganized. person on the dissociative spectrum who had been hospitalized and considered to be psychotic after a suicide attempt, a person diagnosed chronic paranoid schizophrenic after a two-year history of paranoia secondary to marijuana use and a person who had been considered to be chronic paranoid schizophrenic for 7/2 years.
In each case, a dynamic psychotherapy aimed at helping the patient understand the meaning of his or her delusions, thought disorder, paranoia and bizarre behaviors, and recover from psychotic thinking. All three patients were able to titrate down and cease their antipsychotic medication, as they understood the symbolic meaning of his or her previously regressed and distorted mental functioning.
The well attended session was introduced by Dr. Riccardo Lombardi, who spoke fervently of the necessity for trying to make attempts during analysis to understand even the most regressed psychotic patients. Discussants Martini and Rinaldi felt it was not usually possible to provide insight to psychotic patients, and strongly recommended against entering into such an approach with very regressed patients. In contrast to Steinman’s direct and inquiring approach, both discussants talked about the ineffability and the unknowability of the psychotic state, and cautioned practitioners against becoming too involved with psychotic patients in an attempt to provide insight to them. Both discussants felt that such an interpretive intensive psychotherapy, in the style of Frieda Fromm Reichman, should not be attempted or should only be attempted by those well-versed in such an approach.
Needless to say, such diverse views led to a stimulating discussion and question period, with various members of the audience taking sides with either the presenter or the discussants. The highly interesting polarity of views presented led to an impassioned, back and forth encounter, with the conference ending an hour late. All parties agreed that there is a compelling need for both more analytic work with psychotic patients and the presentation of the kind of successful, curative intensive psychotherapy demonstrated by Dr Steinman during the seminar.