Psychotherapists’ experiences of withdrawn psychotic patients

Psychotic patients frequently struggle to relate to the external world and to others, including their psychotherapist. This does not imply that there is no attempt at relating, but rather that the attempt does not seem to acknowledge the full existence of the psychotherapist as other. If the patient’s attempt at relating is missed, they are at risk of being abandoned to the dread of their separation and loneliness. Psychotherapists see the process of establishing some form of relationship with their patient as a key component of a viable therapeutic endeavour. The point at which the withdrawn psychotic patient and the psychotherapist meet potentially marks the beginnings of relatedness disturbed by conflicting needs and wishes, the experience of which can potentially deter psychotherapists from further engagement. In this paper, psychodynamic psychotherapists’ accounts of engaging therapeutically with withdrawn psychotic patients are used to highlight therapists’ experiences and reactions to the specific phenomenon of withdrawal encountered in some psychotic patients. This dynamic is explored via the interaction between the therapist’s multidetermined need for relatedness and the patient’s psychotic withdrawal, and is discussed via three themes; The therapist’s need for relatedness, The therapist’s ego strength, and Reviving relatedness.