Peciccia, M., Benedetti, G. (1996). The Splitting between Separate and Symbiotic States of... Int. Forum Psychoanal., 5:23-37.

(1996). International Forum of Psychoanalysis, 5:23-37

The Splitting between Separate and Symbiotic States of the Self in the Psychodynamic of Schizophrenia

Maurizio Peciccia, M.D. and Gaetano Benedetti, M.D.

We hypothesize that, in the structure of the psychotic self, there is a disintegration between the symbiotic and separate

states of the self, of which the patient is painfully aware: to use a metaphor, the light in the schizophrenic self is split: at

times it is only in wave form, energy (the patient is living in disintegrated symbiosis), at others it is only matter,

corpuscular (the patient is living in disintegrated separation); unfortunately, the wave and the particle are unable to

produce a unitary phenomenon: the light becomes two entities.

Sometimes we see the psychotic living symbiotically, we feel him to be very close to us, he tells us: I am the moon, the sun, the universe. I am you. At other times the patient is in his separate self but, as he is split off from the symbiotic self, his separation is extreme, it is autistic solitude: nothing exists apart from me: the sun, the moon, the universe, are meaningless shadows which I cannot distinguish, you are light-years away from me you are not there. In both of these extreme situations what seems to be missing is the boundary of separation in the state of symbiosis and the

experience of symbiotic duality in the state of separation.

In 1915 Freud noted that in schizophrenia there was a characteristic disturbance of the primary processes, such that

free displacement and condensation of affect between object presentations, instead of taking place between the thing

presentations in the unconscious, occurs between the word presentations in the preconscious.

In schizophrenia, the words themselves in which the preconscious thought was expressed become the object of

elaboration by the primary process. In dreams, on the other hand, the primary process does not operate on

words, but on the thing presentations to which the words have been connected. In dreams a topographical

regression takes place, in schizophrenia, it does not. In dreams, the exchange between cathexis (prec.) of

words and cathexis (unc.) of things occurs freely, whereas it is typical of schizophrenia that this exchange

should be blocked(1).

The problem of the blocking of topographical regression and of the free exchange between the cathexis of words

and the cathexis of things lies at the root of the characteristic language disturbances and of the tendency of the

schizophrenic patient to use concrete thought in place of metaphorical thought. Benedetti and myself (2-5), worked for

six years with eight chronic schizophrenics (average age 31, average duration of illness 11 years) who, amongst other

psychotic symptoms, presented, in particular, evidence of very serious language disturbances. Their verbal stereotypies,

neologisms and bizarre words proved to be incomprehensible, being loaded with a whole series of meanings deriving

from processes of displacement and condensation of a vast number of word presentations. Our patients had a natural

tendency to draw, which we encouraged. The patient, by spontaneously drawing whatever occurred to him, started to

connect word presentations with thing presentations.

When the patient succeeded in illustrating his own verbalizations through his drawings, we began to communicate

with him, drawing an answer which reflected his picture and incorporating within it our reaction to the same. Our

drawings mirrored those of the patient and, at the same time, gave a progressive turn to them, in that they copied

graphic elements of his drawings and shifted them, displaced them and condensed them with other elements provided

by the patient, following our spontaneous visual associations; we were thus the first to use the primary process at the

level of the things represented in the drawings.

It was relatively easy for patients to enter into

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this way of communicating and as the primary process was led back from the word presentations to the thing

presentations the patients returned to using verbal language according to secondary process functioning. This happened

in every case we followed after about 12-24 months when, in the dialogue carried out through images, the patient

managed to build graphic representations which were transitional between himself and the therapist, entrusting to them

the expression of transference emotions and affectsboth libidinal and destructiveof an intensity significantly higher than that which the spoken word at that point permitted.

When we noticed that the disappearance of disturbances in verbal communication proceeded in parallel with the

gradual construction, in the drawings, of a representation of the self which the patient utilized in order to interact

affectively with the therapist, we advanced the hypothesis that the disturbance in verbal communication of the patients

with whom we were working was to be connected with the absence of a symbolic representation of the self.

The figures which emerge in the drawings are extracted from the unconscious of the two partners, where subjects

composed of parts of the therapist and parts of the patient are gradually deposited. These Transitional Subjects (6, 7), expressed graphically, also represent the patient's and the therapist's selves and have the dual function of transmitting to

the self both positive and negative transference and countertransference affects and, at the same time, of protecting the

patient's self from the disintegrating and disorganizing action of emotions.

In schizophrenia, the transference and counter-transference affects have a devastating effect, because the peripheral

part of the self seems to be missing, that part which has developed through object relations and which can be

metaphorically represented as the protective membrane of the cell which has differentiated itself so as to absorb the

impact of the outside world. Our impression is that the protective membrane of the self is composed of a mirror-image

of the self which is formed approximately during the phase of Lacan's (8) mirror, and which develops until it becomes

the symbol of the self. Just as, upon interaction with the environment, the membrane changes in order to maintain

unaltered the inner part of the cell, so the symbol of the self is transformed upon contact with the world in order to

preserve the central nucleus of the self, protected, unchanged, always the same as it was.

The basic biological conflict of all living beingshow to modify themselves upon contact with the surrounding environment and, at the same time, maintain unaltered their own structureis exacerbated and becomes dramatic in psychosis. Here, the lack of membraneof symbols of the selfexposes the inside of the cellthe centre of the selfdirectly, and without any mediation, to the impact of the world. The centre of the self thus pours out and spreads itself

projectively outside.

The central nucleus of the self, when it is faced with and directly modified by the emotions of interpersonal

relationships, loses its function as an organizer and structurizer of world experience within those space-time co-

ordinates which give us the sense of our existential continuity, the sense of always being ourselves, whatever the

situation.

The membrane of the cell, the symbol of the self which we have seen develop in the reciprocal exchange of

drawings, has analogies with that capacity of objectifying oneself that the self of the child acquires before it enters the

sphere of verbal communication at around two years of age (9, 10). The ability to make the self an object of reflection

which may be experienced by another person, the ability to engage in symbolic acts such as play and language

acquisition are connected and interdependent phenomena in a child's development.

The possibility of objectifying the self, in particular, forms the basis for what Lichtenberg (11) defines as the

imaginative capacity, which allows the child to imagine his interpersonal life. With this new imaginative capacity connected with the possibility of objectifying the self, the child is able to transcend immediate experience and keep to

himself the desire for a reality as he would like it (12). This opens up the possibility of a more or less lasting inhibition

of the primitive tendency towards immediate discharge, favouring the transition from the pleasure principle to the

reality principle, from primary thought to secondary thought. Likewise, our patients, at the time when they acquired the

ability to objectify the self, began to utilize the secondary process in the verbal language instead of the primary process.

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Fig 1.

Fig 2.

Fig 3.

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Fig 4.

Fig 5.

Fig 6.

Fig 7.

Fig 8.

The first symbol of the self which appears in the drawings, besides being a Transitional Subject lying between the patient and the therapist, is also a transition between content and container, between inside and outside and, above

all, it is a compromise between symbiotic needs and separative needs which emerge from the transference and

countertransference relationship of the patient-therapist couple. Moreover, the symbol of the self contains elements of

the psychopathology now inserted in a dual context.

For example, an autistic patient who had not spoken for ten years and who performed hundreds of times a day the

stereotyped action of painting

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her eyescovering them completely with black in order to defend herself and separate herself autis-tically from the outside world which otherwise coincided symbiotically with her inner worldovercame this stereotyped behaviour and started to speak when, in the drawings, she created a representation of her self which contained parts of her own self and

parts of the therapist's self. This symbol of the self was then utilized to exchange affects and intense emotions with the

therapist, emotions which had, in the past, fragmented her.

Besides transferal libidinal cathexis, the symbol of the self may also transmit destructive transference cathexis.

In order to reflect upon the nature of the transference and countertransference affects transmitted by the symbols of

the self, we give a brief report of a male patient who had been convinced for 20 years, despite every kind of

pharmacological, social and psychotherapeutic treatment, that secret agents were poisoning his food, causing him

terrible experiences of splitting and bodily fragmentation. Every time he ate he passed from a state of total autistic shut-

off, from a sort of omnipotent independence, to a state of symbiotic fusion, a total dependence. Due to this mechanism,

he was admitted and discharged from the psychiatric hospital dozens of times a year. When the patient passed from the

autistic state to the symbiotic state, he became fragmented and split: the delusion arose out of a compromise between

extreme separative requirements, an autism which led him to reject verbal communication, and a need for symbiotic

fusion with his mother, who had been suffering from the same delusion for years.

In this patient's drawings, we noted that there were groups of images where autistic defences predominated (Fig. 1-

3) and groups of drawings where the symbiotic container component predominated (Fig. 4-7).

One particular characteristic, which was constantly repeated in the about 1,000 drawings produced by this patient,

was the following: between the groups of images where symbiosis predominated and the groups of images where

separatism-autism prevailed, there was never any exchange; it seemed almost as if the primary process was blocked and

that the processes of

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Fig 9.

displacement and condensation were carried out within each level, but never between one level of images and another.

When the therapist tried connecting and condensing the various groups of split images with one another, at times the

patient accepted these connections and adopted them, at others he destroyed them (Fig. 8) or else his destructiveness

was directed against the relationship, causing him to walk out of the sessions or skip them completely.

The repeated confrontation with the destructive drives led to their being partially integrated with the life drives and

the result of this, in the drawings (Fig. 9), was the structure of the scorpion which we considered to be the first symbolic

representation of the self: for the first time after two years of therapy, the patient said, referring to the scorpion: This is me.

The scorpion image, which was later repeated in hundreds of drawings, was composed of a rigid container, the

shell, reminiscent of the autistic barrier, plus a poisonous sting. The poisonous sting was connected with precisely those

destructive drives which gave origin to the poison of his persecutors, and these, through the transference, now began to

be integrated with the life drives in the structure of the scorpion. Indeed, the rigid autistic defenses of the scorpion had

the function of protecting the star, the constant and invariable content deriving from the deep symbiotic union with the

therapist.

Once the image of the star protected by the scorpion had been developed, we noted that the patient made great use

of it, inserting it in all the groups of images which before had been split: in other words, he used it as a lowest common

multiple, like a thread which, via processes of condensation and displacement, sewed back together the various split

levels in the drawings (Fig. 10-12).

The stereomorphisms, that is to say the drawings which schizophrenic patients repeat identically thousands and

thousands of times and which are analogous to the verbal and motor stereoty-pies, changed, in parallel with the

modification in structure of the chronic delusions, precisely when the patient managed to bring about a condensation

between groups of images where the autistic barrier prevailed and groups of images where fusion predominated. This

connection led to a reorganization of the structure of the drawings, so that the groups of drawings which before had

been reciprocally threatening became reciprocally defensive (Fig. 13-14).

In general, the groups of images between which communication has again become possible are arranged in such a

way as to contain each other reciprocally (Fig. 15-16).

Moving onto a metapsychological plane, we hypothesize that the groups of images with a predominance of autistic-

separated figures and the groups of images with a predominance of fusional figures are to be connected with any split-

off psychical levels. We use the term split-off psychical level in the broad sense, to encompass:

- the various levels of classical libidinal development (where at the oral, anal and genital stages the content-

container relationship reoccurs in a more and more symbolized form);

- neurobiological levels of development corresponding to new functions and experiential fields of the self;

- levels of the transference and countertransfer-ence relationship, for example the levels of autism,

ambivalent symbiosis and preambiva-lent symbiosis.

We feel it is important to point out that all these psychical levels appear to be represented in the drawings at the

same time.

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Fig 10.

Fig 11.

Fig 12.

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Fig 13.

Until a symbol of the self appears, one recognized and accepted by all the psychical levels, every form of

communication which takes place via processes of displacement and condensation between the various levels is

threatening, as it causes the existential continuity of the self to be lost and thus leads to fragmentation. The predominant

conflict repeated at every split level seemed to us, in the cases studied, to be taking place between prematurely

separated self presentations and self presentations fused with the objects. Each level seems to produce its own

compromise to the symbiosis-separation conflict, but the solution to the conflict is not recognized by the other psychical

levels; integration and primary communication between levels is thus impossible, as every level, instead of finding itself

represented in the other, seems rather to lose itself in the other.

In our opinion, the cut-off in the communication between thing presentations and word presentations, the absence

of topographical regression in schizophrenia reported by Freud, constitutes a particular feature of the general

phenomenon characterized by the absence of integration, of connection and of communication between psychical

levels. When we pronounce the verbal presentation house, we usually possess a vertical connection between the psychical level of the abstract word presentations and the more archaic unconscious level of the presentations of

concrete things. Consequently, the word house refers to the image of the house I grew up in, to its smell, its warmth and the sense of protection associated with it. In a certain sense, the thing house is the container of the word house, it is identified with it, it is represented in it, it is found there, and does not get lost at a different level. This just does not

happen in the schizophrenic: the word house is not connected up with the thing house, it is not identified with it; on the contrary, it risks losing itself in it.

Our patients had not arrived at any unitary presentation of the self which would be valid for all the psychical levels

and able to structure them and organize them into a single psychical organism. We noticed, for various psychical levels,

a multiplicity of presentations of the separate self and the self fused with objects, but these presentations did not appear

to form a cohesive, unified whole through any sort of lowest common multiple recognized as its own by the various

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Fig 14.

levels. We therefore asked ourselves why each psychical level was trying to resolve the symbiosis-separation conflict

autonomously and why it was that the psyche could not produce a solution recognized by all the psychical levels.

One possible answer is the following: perhaps the conflict arises very early on, at a primitive psychical level, and

remains unresolved at that level. When the maturing psyche passes on to a new, more evolved psychical level (whether

we are dealing with libidinal, relational or neurobiological development), the old level should integrate itself with the

new, uniting with it and finding itself, at the same time, represented in a differential form within the new level. If the

separation-symbiosis (and therefore content-container) conflicts have not been resolved at the more primitive level, one

cannot even verify the presence of connection and integration (which would imply displacement, unification and

condensation with the next level. Indeed, the old level, uniting with the new, would lose itself in it; it would not be

differentiated. The new psychical level thus has to tackle the symbiosis-separation conflict autonomously and without

communicating with the previous level.

The conflict thus remains globally unresolved and crops up anew at every level, right up to the level of verbal

presentations; here, for the outside observer, it proves to be particularly obvious. The preverbal and pregenital psychical

levels, unconnected with each other, are in no way represented at the verbal level, so at times our patients have the

impression that they are getting lost in their own words or in others' words or that they are being killed by them. Every time I speak a part of me dies said one patient, and another declared, addressing his therapist, Your words kill me.

Each psychical level, not being integrated with the others, feels its fragile identity and existential continuity to be

threatened, and therefore organizes itself and protects itself autonomously, using as a defence the aggressive drive

defused by the life drive which, however, inclines towards the unification and integration of the various psychical

levels. Probably, by a similar process, the defused aggressive drives protect, in an autistic form, the delusional

constructsthose psychical levels which, threatened by the anxiety of fragmentation, are to the greatest extent fused with the outside world, an outside reality from which the patient is, however, at the same time, totally isolated.

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Fig 15.

Fig 16.

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The threat that interpersonal relationships pose for the patient derives in part from the fact that the relationship with

the outside world and with others implies in the patient the activation of a variety of internal psychical levels which are

not integrated with each other, thus promoting fragmentation and a loss of consistency and existential invariability in

that fragile level around which the patient identified himself.

Returning to the unresolved symbiosis-separation based conflict, which might also be defined as a content-

container conflict, we hypothesize that it occurs extremely early on and that it acts primitively to prevent the integration

between the separate state and the symbiotic state of the self. For reasons of simplicity, in developing this hypothesis we

shall use the terms disintegrated separate self and disintegrated symbiotic self even if the situation is more complex and one ought, more properly, to speak of disintegrated psychical levels where, in the separation-symbiosis conflict, the

nuclei of autistic separation predominate and of disintegrated psychical levels where, in the separation-symbiosis

conflict, the nuclei of symbiotic fusion predominate.

Stern, on the basis of numerous, careful observations of childhood development, posits that there is in an infant,

almost from birth, a fused self-other entity (which we term disintegrated symbiotic) in addition to an isolated self (which we define disintegrated separate). According to Stern, in the very early stages of child development, the infant's sense of self is in a dynamic fluctuating state and thus always potentially in that danger of fragmentation that

Winnicott (13-15), has expressed using the term primitive anguish or unthinkable anxiety, amongst which we recall the loss of sense of continuity of existence, going to pieces, losing contact with the body, total isolation due to the lack of means of communication.

Probably, right from the first days after birth, the dynamic, fluctuating state of the infant's sense of self oscillates

between a dimension of separation from the mother's self and a dimension of symbiosis with the mother's self. The

dimensions of separation and of symbiosis, both simultaneously present from birth, are initially alien to and

unintegrated with one another, and the transition of the sense of self from one to the other entails the experience of

fragmentation. In the healthy adult, these dimensions of the self, when well-integrated, constitute a single, harmonious

self; they are, to use a metaphor, like light which, although it has a dual nature, corpuscular and electromagnetic,

appears to be one thing. For interpersonal relations to come about, a perfect or near-perfect co-operation is required

between the symbiotic self and the separate self.

In the contact with another person, the separate self of one person receives and transmits information and emotions

to the separate self of another person, and this exchange may determine more or less significant changes which prove to

be tolerable and anxiety-free only if, at the same time, the interpersonal contact is established, on an unconscious plane,

through the symbiotic self. While, consciously, we live in a dimension where we are separate from one another, at an

unconscious level, in the symbiotic mode of functioning of the self, we experience the illusion that the other person is

the mirror of the symbiotic self (in other words, a mirror for the inner symbiotic pair, container-content). Whereas, as a

separate and conscious particle, the self comes into contact with the other person, exchanging information and changing

as a result, as an unconscious wave, the self has the impression of being within the other person or of being the other person. This process forms the basis for projective identification, which we consider, in accordance with Bion, not only an omnipotent fantasy of the individual, but something which really happens between two people (16).

Even when, during the normal maturation process, the conscious, separating-off from the outside, relinquishes the

magic of primary thought and the narcissistic illusion that the outside world and the inner world are one and the same,

in the unconscious, onyric thought, which is still active even during wakefulness (17), remains under the dominion of

this illusion. This omnipotent unconscious illusion, this normal onyric narcissism, is indispensable for human well-

being: from it are continuously drawn the energies necessary to accept the disillusionment of the relationship with the

outside world, based on the reality principle. This is not confined to the early stages of childhood development, but

continues through to the healthy adult. In the words of Searles (18):

daily living, even in adulthood, involves continual increments of illusion and disillusion, and, in successful

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maturation, an increasing skill in experiencing illusionment and disillusionment both object-relatedness and symbiosis are essential ingredients of healthy human relatedness.

Symbiotic self and separate self, illusionment and disillusionment, omnipotence and impotence, are for us

integrated and continuously-present lines of development (even if they are never completely conscious) over the course

of a whole life.

We hypothesize that, in the structure of the psychotic self, there is a disintegration between the symbiotic and

separate states of the self, of which the patient is painfully aware: to return to our metaphor, the light in the

schizophrenic self is split: at times it is only in wave form, energy (the patient is living in disintegrated symbiosis), at

others it is only matter, corpuscular (the patient is living in disintegrated separation); unfortunately, the wave and the

particle are unable to produce a unitary phenomenon: the light becomes two entities. Sometimes we see the psychotic

living symbiotically, we feel him to be very close to us, he tells us: I am the moon, the sun, the universe. I am you. At other times the patient is in his separate self but, as he is split off from the symbiotic self, his separation is extreme, it is

autistic solitude: nothing exists apart from me: the sun, the moon, the universe, are meaningless shadows which I cannot distinguish , you are light-years away from me , you are not there.

In both of these extreme situations what seems to be missing is the boundary of separation in the state of symbiosis

and the experience of symbiotic duality in the state of separation. We thus return to the root of the term schizophrenia,

split thinking, meaning, however, by split thinking something underlying the split thinking Bleuler (19) described.

Bleuler's splitting, the delusion, the autism, the repression of affect, seems to us to be a consequence of the split

between the symbiotic state and the separate state of the self.

Let us consider, for example, the repression of affect, which concerns both positive and negative affect. A positive

affect may determine a transition from the separate state to the symbiotic state. This may be natural and pleasurable in

someone who can count on an integrated self. It is not so for the psychotic, in whom the transition from separation to

symbiosis can mean death, the anihilation of one state (the separate one) which is radically different from and alien to

the symbiotic state, and for this reason, greatly feared. A male patient once said to me, terrified: If I transfer myself onto you, I shall lose myself. How often this same patient had also said to me that my eyes were his eyes, that we were brothers, that we reflected each other. It was not the experience of symbiosis he was lacking, but the passage leading

from separation to symbiosis and vice versa.

So, let us suppose that the patient is in the state of symbiosis; a negative affect might tend to take him back to a

state of separation. This happens at times even in the mentally healthy: a loving embrace which makes us feel one with

our partner is broken if the loved one says something which makes us feel angry. The anger takes us back from the

symbiosis state to the separation state, and this is unpleasant.

However, in the psychotic patient, this may cause fragmentation and panic. The delusion may then constitute an

invariable zone, a non-verifiable and unreachable structure of reality, sheltered from emotions and transformations, a

zone which allows the patient to go on living, for as long as possible, either in the separate self or in the symbiotic self.

All the emotional stimuli which may cause him to pass from one state to the other are therefore experienced as life-

threatening persecutions. The deep-seated disintegration between the two states actually makes them alien to and

incompatible with one another: between them opens up the abyss of nothingness, of non-existence, that timor vacui which so many of our psychotic patients describe in dramatic ways.

Whereas Klein (20) tells us that primordial anxiety and the threat of inner annihilation is always the result of the

death instinct, we hold that, in some cases, anxiety relating to fragmentation and annihilation derives from the transition

from one state of the self to another, and that this is basically due to the functioning of the life drive. The infant's self

then defends itself from any change in state using defused investments which are predominantly aggressive in nature.

These may be reinforced by frustrating experiences connected with unpleasurable transitions from one state of the self

to the other, giving rise to the bad self and bad objects, or mitigated and neutralized by transitions of the self from one

state to another which are associated with experiences of satisfaction and pleasure, from which derive the good self and

good objects.

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Therefore, we hypothesize (Table I) that the libidnal drive, which tends to integrate and unite, is responsible for the

oscillations of the infant's self from the self's symbiotic state to the self's separate state and vice versa; this fluctuation of

dimension between the self's states, which are initially disintegrated, is probably connected with death experiences.

If the fluctuation of the self from one state to the other is experienced serenely and pleasantly, we have a good death (from which a good self and a good object-self are derived); if the fluctuation of the self from one state to the other is experienced with anguish, fear of fragmentation or in some other unpleasant way, we have a bad death (from which a bad self and bad object-self are derived).

If it is possible to admit the presence of a death drive, in our opinion it is connected with and derives from the life

drive which has within it a double tendency: a progressive one which provokes the self's fluctuation from one state to

the other and a self-preserving one which tries to maintain the status quo by opposing the fluctuation of the self from

one dimension to the other.

The good self-bad self, good object-bad object integration, together with the consequent fusion of the instincts, the

differentiation between self and object presentations (21, 22), probably proceeds in parallel with the integration between

the psychical levels where the separate state of the self predominates and those where the symbiotic state prevails. The

separate and symbiotic states of the self basically reflect the experience of the self in Mahler's autistic and symbiotic

phases (23). However, whereas we hold that the separate state (disintegrated, and thus autistic) of the self and the

symbiotic disintegrated state of the self co-exist, for Mahler the autistic phase precedes the symbiotic phase and,

according to the point of fixation, we should expect to find symbiotic psychoses or autistic psychoses.

Our impression is that, even in the psychoses where autistic symptomology is predominant, it is possible to detect

split-off psychical levels of intense symbiosis and vice versa. In those psychoses where symbiotic problems prevail, the

autistic levels are less obvious because they are completely split off, but this does not mean that they are absent or less

intense. This explains why patients with typically autistic psychoses may suddenly present ways of typically symbiotic

relatedness and vice versa.

At this point we can take into consideration the problem of compatibility or incompatibility of the psychoanalytical

models in the interpretation of schizophrenia.

Cancro (24) reminds us that theories should not be considered as simply true or false, but assessed according to

their utility (25), their falsifiability (26) and their heuristic valuein other words, their capacity for stimulating and

guiding research and developing new theories. At times, in the evaluation of a model, one comes up against that risk

indicated by Feinsilver (27), whereby: Data consonant with one's own assumptions are taken as totally good, whereas incompatible data are seen as totally wrong and bad. A similar dichotomic attitude, present in the story of the development of psychoanalytical thought, may be connected with overly concretized counter-identifications with the omnipotent wishes of our patients, which remain at an unconscious level.

The setting-up of a scientific model is an act of creation and, as such, it belongs to the transitional area of

illusionment and normal omnipotence; to ignore this fact may lead to excessive involvement with one's own theory,

which is then defended unconditionally and rendered inaccessible to criticism and to the disillusionment necessarily

involved in confrontation.

The principle that a theory is criticizable and may be proved wrong is indispensable if a selection is to be made

amongst the various theories, bringing man as close as possible to the right interpretation of the world, moving him

from the subjective need to be eternal and unchanging towards a need for objective knowledge about the internal and

external reality in which he lives (which does not necessarily exclude man's subjective need, but leads him closer to

knowing, as precisely as possible, how nature responds to this). Thus, the mutual compatibility or incompatibility of

psychoanalytic models does not lie in the cognitive analysis of the common or divergent areas of the various theories

semantically-speaking, as much as in the affective-cognitive field connected with the awareness that, through this

model, the therapist identifies to a certain extent with his patient.

The therapist who is aware of and accepts the fact that his model also contains his own

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Table 1.

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narcissistic nuclei, which are unconsciously projected onto it, recognizes the omnipotent illusion which forms an

integral part of the process of creation of the theoretical model and uses it to better approach the extraneous nature of

the psychotic's experience. This then appears to him as a transitional structure lying between himself and the patient,

and out of this arises the therapeutic possibility of proposingusing the parts remaining outside the symbiotic areas of the relational field dominated by crossed projective identification (28)new solutions to the psychotic situation which are partially shared in the transitional subject-model, solutions the patient cannot reach alone.

These possible solutions may also be represented by repeated experience of the good object, by the new edition of

the pathological symbiotic phase in the therapeutic symbiosis, by the retrieval of the illusion of normal omnipotence

and even, in our language, by separate self/symbiotic self integration. The therapeutic experience remainsin the patient as in the therapistessentially the same, and it depends more on the personalities of the two participants in the process than on the analyst's theoretical model of reference. Moreover, its variations depend, in our case, more on the

medium of communication used (words or drawing) than on the cognitive construct present in the mind of the therapist.

What really counts and establishes the compatibility of the different models is the way in which the two

participants in the therapeutic experience together build up the validity of their relationship.

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2 Benedetti G., Peciccia M. L'art en psichiatrie et le processus psychothrapeutique. Psychothrapies 1991; 4: 193-206.

3 Benedetti G., Peciccia M. New insight in the psychotherapy of adolescent schizophrenics. In: Eggers C, ed.

Schizophrenia and youth. New York-Berlin-Heidelberg: Springer, 1991.

4 Peciccia M., Benedetti G. Das progressive therapeutische Spiegelbild. Eine neue Methode in der Psychotherapie der

Psychosen. Neurologie und Psychatre 1989; 3: 296-304.

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