The role of psychoanalytic theory and practice in understanding and treating schizophrenia: a rejoinder to the PORT report's condemnation of psychoanalysis.

The Schizophrenia PORT report rejects, in recommendation 22, the use of psychodynamic therapies. It also rejects, in recommendation 26, a crucial point of psychoanalytic theory by rejecting family interventions based on the assumption that the family of origin can make a ca usal contribution to schizophrenia. Both recommendations are based on level "C" evidence, which is defined by the authors as a: "Recommendation based primarily on expert opinion, with minimal research-based evidence, but significant clinical experience" (Lehman et al., 1998, p. 2). Conclusions based on low-level evidence would be better formulated in tentative rather than categorical statements as is now done in the PORT report. More substantially, I report on a number of empirical studies that contradict the claims of recommendations 22 and 26. I therefore urge that the two PORT recommendations be revised. I argue that the recommendations can be rewritten so that a useful point in each of the recommendations can be preserved and even strengthened. With reference to recommendation 22, it is wise to stress that psychoanalytic-inspired therapies with schizophrenics should not simply apply the same methods used in the treatment of neurotics. With reference to recommendation 26, it is important to stress that imposing or augmenting guilt is not a good therapeutic technique. Similarly, it is not good therapeutic practice to deny the truth. To tell the truth and not create guilt requires artful interventions. If recommendations 22 and 26 were to be rewritten as suggested, they would become scientifically defensible and would make a positive contribution by stressing the contributions that many approaches, including psychoanalysis, can make to the treatment of schizophrenia. As they stand now, recommendations 22 and 26 are contradicted by the scientific evidence I will submit.