DIRECT ANALYSIS

A therapeutic approach developed by John Rosen, in which an attempt is made to understand and communicate directly with the unconscious of psychotic patients. The method utilizes psychoanalytic theories as well as techniques which are ordinarily applied only to patients with neuroses.Rosen’s approach is based on the theory that the behavior of the psychotic patient, no matter how bizarre it may appear, is actually an attempt to communicate. If the therapist understands the logic of the unconscious and studies the meaning behind the patient’s idiomatic verbalizations, he will be able to enter into an interchange with him on both a verbal and emotional level, and thereby lay the foundation for effective psychotherapy. Rosen maintains that this can be accomplished with every patient, no matter how regressed, unreachable, or incurable others believe him to be. (Rosen, 1953)Rosen believes that every functional psychosis is due to severe emotional deprivation during the oral stage of development. The patient’s condition is, as McKinnon puts it (1959), “analogous to the state of a helpless infant in terror of starvation in this early period of life.” The therapist must therefore provide the affection and understanding which the patient missed as an infant. In fact, he must accept the patient as a member of his own family, and act as a loving parent who is deeply involved in his welfare and who will be unhappy until he is at peace with himself. In carrying out this form of therapy, the patient actually lives in a home with Rosen’s assistants, and Rosen treats him in the presence of this “psychological family.”In essence, the treatment consists of having the patient relive early traumatic experiences with the mother. In this process the original image of the mother is destroyed in order to induce him to give up the delusions and fantasies he has developed as a reaction to emotional deprivation. At the same time Rosen and the psychological family give the patient the “emotional nutriment” he needs for a more healthy development.In direct analysis the therapist makes a head-on attack on the patient’s delusions. He actually participates in the patient’s world of fantasy, and shows him that he has nothing to fear from the voices or visions which frighten him. If the patient says he would like to go to the sun, Rosen replies that he was going to visit it that afternoon and would take him on the next trip. If the patient claims he is God, Rosen says, “Prove it!” He may even tell patients who deny their psychosis that he was himself psychotic and had the identical symptoms, but was cured—a device he uses to remove the secrecy of illness and to indicate that cure is possible. When patients have improved to some extent and their resistances have begun to dissolve, he may use direct reciprocation by answering curse with curse or silent treatment with silent treatment. On the other hand, with patients who have regressed so far that words have lost their meaning, he may shout or slap to capture their attention and awaken them to reality. Or he might squeeze the hand of a mute patient to get her to scream, and then use this as evidence that she feels real pain. These drastic measures are employed not only to shock patients into reality but to show them that a truly loving “parent” can be powerful, and yet use his power to protect and not to harm them. Rosen claims that they accept this treatment because of their strong positive transference to the therapist and their feeling that he is acting in their best interests.According to Rosen, the duration of the treatment depends upon the length of time the patient has suffered from the psychosis and the type of prior treatment which has been used, not on the degree of deterioration or the type of psychotic reaction. He claims to have freed patients from a psychosis in a period of weeks, especially when it is of recent onset and shock therapy or other organic treatment has not been applied. When the patients have given up their psychotic symptoms, they develop neurotic symptoms (a “neoneurosis,” as he calls it), but this phase can be overcome by close foster parent guidance.Rosen has reported a high percentage of recoveries, but the great majority of psychiatrists are skeptical about his methods and their effectiveness. An Institute for Direct Analysis has been established at Temple University Medical Center to evaluate this technique and determine whether it can be formulated for teaching purposes.