1st Edition

From Breakdown to Breakthrough Psychoanalytic Treatment of Psychosis

By Danielle Knafo, Michael Selzer Copyright 2024
    306 Pages
    by Routledge

    306 Pages
    by Routledge

    As a clear and user-friendly guide for clinicians who work with patients affected by psychosis, this book challenges the false notion that psychosis is untreatable through talk therapy.

    The authors contend that since psychotic symptoms are features of survival adaptation, they naturally serve as a valuable source of information, providing clues about the origins of people's psychic derailment along with a path to its cure. The authors advise therapists not only to read and respond to the messages embedded in the symptoms, but also to recognize and utilise the non-psychotic aspects of the patient in facilitating recovery. The overall aim is to recruit the patient as a collaborator in their treatment, thus wresting a meaningful and redemptive narrative from the psychotic experience. All aspects and phases of treatment - from initial encounters through the middle phase to termination, and even supervision - are covered in this volume.

    Abundant with clinical examples, theoretical and technical points, and treatment methods, this book is essential reading for all psychotherapists, psychoanalysts, and other mental health clinicians working with psychosis. 

    Foreword by Orna Ophir  Introduction: From Breakdown to Breakthrough  1. Psychoanalysis meets Psychosis: Theory and Practice  2. Beginnings  3. Establishing a Pre-Alliance  4. Sample First Session: Psychosis and Cannabis  5. Outpatient Treatment with Psychosis: Managing Isolation and Creating Safety  6. "Don't Step on Tony!": Working with Psychotic Symptoms  7. Anybody Home? Working with Negative Symptoms  8. Alone in a Crowded Mind: When Psychosis Masks Loneliness  9. Coming Undone: Acute Decompensation and Creating a Narrative  10. Going Blind to See: A Case Study of Trauma, Regression, and Psychosis  11. Endings  12. Supervision


    Danielle Knafo, Ph.D., is a clinical psychologist and psychoanalyst with expertise in the treatment of psychosis. During her tenure as professor at LIU's Clinical Psychology Doctoral program for 22 years, she chaired a concentration on serious mental illness. She is faculty and supervisor at NYU's Postdoctoral Program in Psychoanalysis. She has written and lectured extensively on psychoanalysis, trauma, and psychosis. 

    Michael Selzer, M.D., is a psychiatrist who directed the Schizophrenia Division at NY Hospital, Westchester Division. He was also clinical associate professor at NY Downstate Medical Center, where he was director of medical education in psychiatry. He has taught and written about the treatment of psychosis and borderline personality disorder.

    'While reading From Breakdown to Breakthrough, my highlighting pen rarely left my hand, so much was there to note and remember. With crystal clarity and great style, the authors thoroughly refute the despairing deficit model of psychosis by offering a brilliant theoretical synthesis supported with a wealth of references and tied to a potent and practical approach to understanding and responding to the language of the disorder. Their powerful arguments are given felt resonance through many profound and poignant case histories. This book is a victory for the psychoanalytic treatment of psychosis, and I found myself applauding nearly every page.Mental health practitioners of all types, especially early career psychotherapists, will be greatly helped in knowing how to treat those deemed unreachable as they learn to decipher and work with symptoms as forms of communication.'

    Francoise Davoine, Ph.D., French psychoanalyst and co-author of History Beyond Trauma

    'From Breakdown to Breakthrough is a passionate, responsive, and highly educated exploration and sharing of psychological work with psychosis, emphasizing intricacies of the therapy relationship, its nuances and possibilities. Psychoanalytic, psychodynamic, and relational perspectives open doors of contact, healing, and growth. This book is a beautiful exposition and affirmation of ways the human spirit connects with difficult, often seemingly intractable, states as it supports and mediates transformative processes.'

    Michael Eigen, Ph.D., is a psychoanalyst and author of The Psychotic CoreThe Sensitive Self, and Contact with the Depths

    'This is a terrific book! Knafo and Selzer are master clinicians who work with the skill, determination, patience, and grace required to give patients who are in psychological retreat from consensual reality an opportunity to risk re-entering a world they came to find too difficult to bear. The authors present a persuasive case for regarding psychotic symptoms as essential sources of information that provide a foundation for the patient's treatment. They illustrate their approach with many clear and moving clinical examples. They share their intuitions, formulations, and decisions as their work unfolds with individual patients. The book is full of clinical wisdom, important ideas, and practical advice. It is certain to be of value to experienced clinicians and early-career psychotherapists alike.'

    Michael Garrett, M.D., psychiatrist, psychoanalyst, and author, Psychotherapy for Psychosis

    'From Breakdown to Breakthrough is a wonderful book based on extenstive knowledge and experience, which clearly outlines a potent psychodynamic approach to assist persons suffering psychosis in achieving a fuller life. Both novice and veteran mental health professionals will gain useful insights from any of the chapters.The book is written in a style that will readily engage the reader and, in doing so, also demonstrate much better ways of engaging with one's patients.'

    Brian Martindale, M.D., psychiatrist and psychoanalyst in the UK, past president of the International Society for the Psychological and Social Approaches to Psychosis (ISPS)