Interview with Gaetano Benedetti, M.D.

By Brian Koehler, Ph.D.

While in Stavanger, Norway attending the 13th International Symposium for the

Psychological Treatments of the Schizophrenias and Other Psychoses, June 5 - 8, 2000, I had the

honor to spend time with Gaetano Benedetti, MD and his younger colleague in the field of

schizophrenia, Maurizio Peciccia, MD. For six months prior to my encounter with Professor

Benedetti, I had been meeting with several colleagues on a biweekly basis to discuss the clinical

theories of Drs. Benedetti and Peciccia and to compare these with the work of Harold Searles, MD.

I would like to thank those colleagues and friends who participated in that seminar: Paul Carroll,

Joyce Epstein, Larry Freeman, Julie Kipp, Christine Miller, James Ogilvie, and Janet Ottmann.

In this article, I will present excerpts from an interview I did with Drs. Benedetti and

Peciccia on the morning of Professor Benedetti's address to the congress and a panel discussion in

which Dr. Benedetti's work figured prominently. This panel consisted of myself, and Drs. Peciccia

and Gary Bruno Schmid, all of whom including my New York colleague, Julie Kipp CSW,

participated in the interview. Dr. Schmid assisted Professor Benedetti in translating German into

English. Although the interview was primarily with Gaetano Benedetti, his responses seem to be

also the product of a fruitful collaboration with his colleague, Maurizio Peciccia.

Gaetano Benedetti joined the psychiatric staff at the Zurich University Clinic Burghlzli in

Switzerland in 1947 (two years prior to Harold Searles' joining the staff at Chestnut Lodge). It was

at the Burghlzli Clinic that Eugen Bleuler (1857-1939) created the term "schizophrenia" and

studied the psychodynamic life of schizophrenic patients in close cooperation with Carl Gustav

Jung, and also Sigmund Freud. Manfred Bleuler, the son and successor of Eugen Bleuler as

director of the Burghlzli, described Benedetti as a "highly valued member of our staff" and that the

staff "were increasingly touched by his devotion to schizophrenic patients and by his ability to

understand their psychodynamic life" [cited in G. Benedettis 1987 book, Psychotherapy of

Schizophrenia]. Bleuler noted that Benedetti's empathy for his patients was similar to that of his

father's. As the era of psychopharmacology began, reserpine from India came into use at the
Burghlzli in the 1950's, and Benedetti increasingly focused his work on the psychoanalytic

psychotherapy of psychotic patients. He worked closely with Gustav Bally, Medard Boss,

Marguerite Sechehaye, and Christian Mller (with whom he founded the International Symposium

for the Psychotherapy of Schizophrenia in 1956 at the psychiatric clinic at the University of

Lausanne). In 1956, Benedetti was appointed professor of psychotherapy at the University of

Basel. He continued his work with schizophrenic patients until he retired in 1985. Benedetti has

remained active until the present in his teaching and supervision of clinicians involved in the

psychotherapy of schizophrenia. Bleuler noted that "Benedetti discovered again and again that,

behind his psychopathology, a schizophrenic person has an intellectual and emotional life as do

normal people... It is a great task to break through the isolation of the schizophrenic, whether

permanently or only for a brief time. This great experience plays an important role in Benedetti's

therapy and teaching." Benedetti, later in his career, regarded his work with schizophrenic patients

to be devoted not so much to the transmission of insight, but to "transitional subjects, of therapeutic

dreams which straighten out the negative images of psychosis, of mirror phenomena arising from

the creation of symbols of progressive psychopathology of therapist-patient symmetries, of

transforming images." Benedetti calls for an integration of our "wandering with the patient in the

desert of his psychosis with the growing concerns of social psychiatry."

I will begin with a quote from Professor Gaetano Benedetti (1992), who has over 50 years

of experience doing individual psychoanalytic psychotherapy with persons diagnosed with a

schizophrenic disorder:

"It is in the psychotic's suffering that the most serious problems of the human mind are

encountered. Tackling them means illuminating the human being with signification and

sense, gaining a better understanding of the human being in general, not only of the

psychotic person" (p. 15).

GB: Now I am happy that the co-workers and friends of mine are here, on one side, Dr. Schmid,

who will help me in the translation. I will try to say something in the English language but

he can translate better. On the other side, Dr. Peciccia, who is my co-worker in the field of

schizophrenia, symbiosis and all of these arguments. I have here, Dr. Koehler, your
 questions [these were given to Professor Benedetti ahead of time, prior to the interview in

Norway]. I will try to answer in English the most important questions, and then I will give

the words to Dr. Peciccia.

BK: Dr. Benedetti, how would you define the basic problem in schizophrenia from a

psychological perspective?

GB: In schizophrenia, the transference and countertransference affect has devastating effects,

because the peripheral part of the self seems to be missing, that part which has developed

through object relations [this is similar to Peter Fonagy's dialectical model of self

development] and which can be metaphorically represented as the protective membrane of

the cell which has differentiated itself so as to absorb the impact with 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 (1966) 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 preserve 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 beings - how to modify themselves upon contact

with the surrounding environment and, at the same time, maintain unaltered their own

structure - is exacerbated and becomes dramatic in psychosis. Here, the lack of membrane -

of symbols of the self exposes the inside of the celf - the center of the self - directly, and

without any mediation, to the impact of the world. The center 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 structurlizer of world experience within those space-time coordinates which

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

the situation.

BK: Professor Benedetti how do you define therapeutic symbiosis, is it a necessary part in the

work, and how do you feel your concept of therapeutic symbiosis is different from that of
 Harold Searles?

GB: Therapeutic symbiosis can be considered as the therapeutic sublimation of that pathological

symbiosis which lies at the very core of schizophrenia and which Eugen Bleuler termed

"transitivism" and "appersonation," where the patient because of the disorders of his ego

boundaries as Paul Federn said, confuses himself with the world, with the objects upon

which he projects the bad parts of his self. The sublimation of this process in therapy is

possible because of the so-called narcissistic transference in which the patient confuses

himself with the therapist and it is possible insofar as the symbiosis with the therapist

becomes therapeutic as the therapist projects back to his patient the positive mirror-image of

the patient. The identification of the patient's ego with the object upon which he had

projected the bad side of himself, in order to get rid of it, fragments the ego of the patient,

whereas the therapist tries continuously to nourish this ego, projecting upon him the

positive image of himself.

The concept I use is very near, I think, to that of Searles as I see it. However, there are two

differences. One is of a functional nature and implies the concept that the symbiotic ego is

noted in the human unconscious and is present in all of us, as I and Dr. Peciccia have

described in our articles. We all have a symbiotic ego which is integrated with the separate

ego. Margaret Mahler spoke of the symbiotic ego of the infant with the mother and Daniel

Stern of the separateness. Now these two states are integrated in the human being and the

two states are disintegrated in schizophrenia. Schizophrenia is the de-integration of these

two states. Now this is one difference from Searles, that I speak of the symbiotic ego in

general terms. The second difference is that therapeutic symbiosis in therapy does not

[need] to be interpreted as a transference because the patients experience of the therapeutic

symbiosis develops on a preverbal level and develops to the experience of duality because of

the formation of the transitional subject.

Now there is another question, is the transitional subject of mine the same as the transitional

object of Winnicott? I would say no, because the transitional object of Winnicott is the

whole self of the child which encounters himself in the world. My transitional subject is a
 dissociated self, a part of the self which needs the cradle of the presence of the therapist in

order to become his whole self. It is a part of the self of the patient which becomes the total

self as a transitional subject which includes the figure of the therapist. Let us think of a

voice hallucinated by the schizophrenic patient, which however tells the patient how to

overcome his fears, or a good interpretation of his symptoms. In a case, for instance, where

the patient was afraid even of singing birds, because they knew him and persecuted him, the

voice said, go into the garden and listen there to the voice of God. This hallucination

was still, as such, a psychotic symptom; but as I used to say, a progressive one, a

psychotic symptom with a communicative, antipsychotic intention. The voice was, as the

patient soon said, also a personification of the therapist, it was his presence in him. This

transitional subject was a hallucination of the patient as well as the presence of the therapist

in his unconscious; it was both, the patient and the therapist.

MP: A patient becomes psychotic through the use of marijuana and in his delusion he wished to

meet up with the extraterrestrial. And it comes, and a voice says to him, If you wish to

meet us, you have to stop smoking hashish. It is the voice of the therapist through the

hallucination.

GB: Yes, and have you to say something else concerning symbiosis?

MP: Yes. I would like to say two points. One point is that in the pathological symbiosis, the

patient loses his own individuality, his own ego boundaries, and his own separate self. And

in the therapeutic symbiosis, the patient rediscovers his own boundaries, his own separate

self in the therapist.

GB: Why?

MP: The patient tries to seek a reflection of himself in the world, but the world doesnt mirror

this, his self, because in general no one identifies himself with psychotic people. On the

contrary, the therapist is there with the intention to mirror the identity of the patient and the

identity the patient creates in the intrapsychic space of the therapist.

GS: Can we say that it is the empathic identification of the therapist with the patient which makes

this bridge possible?

GB: Yes.

BK: Professor Benedetti, your term counteridentification describes the patients identification

with the therapist who is able to identify with the patient. Counteridentification in your

thinking is from the patients side?

GB: Well, perhaps the main difference between countertransference and counteridentification is

that in the countertransference there are many symbolic and perhaps neurotic projections of

the therapist upon the patient. Therefore, the countertransference can be sometimes

dangerous to the patient if there is no supervision, if the therapist is not analyzed, etc. The

counteridentification is coming mainly, not completely, but mainly not from the symbolic

past, but from the present day feelings the therapist has towards a psychically dying human

being. Therefore, this counteridentification comes before the identification of the patient

[with the therapist]. The first step is the therapeutic counteridentification.

BK: That is the first step?

GB: Sometimes. I remember that Dr. Peciccia had a dream of a patient before he had met her.

MP: About her psychodynamic problems.

GB: Its like a transference. Countertransference and counteridentification are therapeutic

phenomena. Identification and transference come from the patient.

MP: We would say that there is a symbiotic self and that at different times the patient or therapist

come in contact with this symbiotic self. When the therapist comes first in contract, takes

awareness of the symbiotic self, this is what we call the counteridentification. When it

happens in the patient, then we speak of identification, but it is the same process.

GB: Yes.

MP: I would like to say something also on your very interesting idea, that in regard to the

symbiosis, we must not interpret it verbally because it developed in a preverbal phase. So

we use preverbal methodology (like paintings, progressive mirror drawing, etc.). I think this

is very important and if we use words, then we use them to describe this preverbal level, at

the level of symbiotic and autistic transferences.

GB: Preverbal processes.

MP: In this way we interpret the transferences indirectly.

GB: Yes.

MP: Without saying directly what is happening between patient and therapist [This is

reminiscent of Marguerite Sechehayes avoidance of direct personal address to her patient

Renee, and the Lacanian analyst Palle Villemoes injunction to therapists of psychotic

patients to avoid the use of personal pronouns for they isolate and create a sense of anxious

separation in the patient]. For example, through drawings or through movement.

GB: Yes, yes. Perhaps this is the main difference between a psychoanalytic treatment and this

psychodynamic treatment, the conception we have of the disease is a psychoanalytic one, but

the talk with the patient is not psychoanalytic. It is an imaginative talk where we express

ourselves either through pictures, or through words which describe preverbal processes, and

not intellectual, rational processes like in psychoanalysis.

BK: Psychoanalysis is not just about interpretation of transference resistances.

MP: There are psychoanalysts, particularly in Buenos Aires, who used the indirect interpretation

of the transference not with drawings but with the narrative of the history.

BK: You use the word psychosynthetic in some of your writings.

GB: Yes.

BK: It refers to the nourishing of the psychotic ego?

GB: Psychoanalysis is the uncovering of the unconscious layers and backgrounds of the

psychotic symptoms like hatred, narcissistic wounds, rage, delusions, hallucinations, etc. It

helps to discover at their origins dangerous life experiences. I think these psychoanalytic

interpretations may be useful, for instance, if there is a negative transference of the patient. I

would say that the positive transference should not be interpreted. It is a reality, a new

reality of the patient. But the negative transference, where the patient hallucinates the

therapist as a persecutor must be interpreted. Psychosynthesis is the patient-therapist

common building of a new self-identity emerging out of the experience of the therapeutic

relationship.

BK: A mutually constructed identity?

GB: Yes. Its a new self identity of the patient and perhaps also of the therapist. I come to your

question, What do you think of Searles concept of patient as therapist to his analyst? I

would not use this expression, but the encounter with schizophrenic patients may be a great

existential experience, which changes our self-identity, and that the schizophrenic patient is

in this situation not only receiving but also giving, so that this mutuality may increase the

strength of his positive transference and his self-esteem also.

BK: In one of your articles, Illuminations of the Human Condition in the Encounter with the

Psychotic Patient [contained in Professor Benedettis book, Psychotherapy of

Schizophrenia as well as in Attachment and the Therapeutic Process: Essays in Honor of

Otto Allen Will, Jr., M.D., edited by J. L. Sacksteder, D.P. Schwartz, and Y. Akabane], you

say, We communicate to him not only what he [the patient] objectively speaking, appears

to us to be . . . the object of psychodynamic mechanisms; we also communicate to him the

meaning his existence holds for our own . . . It is only in this way that we communicate to

him an image which is not only reductive of himself, but prospective, and we communicate

to him also an image of ourselves which may enrich and transform his image of himself. In

this art of communication, which is reflected by him to us, we too are changed, and it is this,

our very ability to let ourselves be transformed, deepened, and enriched, which has an effect

upon him. Searles had a very similar concept.

GB: Yes.

BK: There is something that happens in long-term work with psychotic patients where

underneath or alongside of the negative transference is always, I think, this attempt by the

patient to have a positive impact on the therapist. As Herbert Rosenfeld pointed out, one of

the unconscious psychotic anxieties is the fear of having a destrucive impact on the other,

perhaps driving the other mad. And as Searles clarified, the latter may be both a fear and a

wish. Searles believed one of the primary anxieties in paranoid schizophrenia was this fear

of having an omnipotent destructive impact on the needed other. In fact, we use for our logo

for the *ISPS-US newsletter.

[*This is one of two newsletters published by ISPS. For information on ISPS membership and
their newsletters, contact Brian Koehler at (212) 533-5687 or B.Koehler@psychoanalysis.net]
BK: Searles comment, ...innate among mans [the persons] most powerful striving toward

his [ones] fellow man [human beings] ...is an essentially psychotherapeutic striving.

This striving must be recognized and acknowledged in order for the patient to further the

assumption of her or his own identity.

MP: I agree with this idea, and I have had the experience in the progressive mirror drawing

[see M. Peciccia and G. Benedetti, The integration of sensorial channels through

progressive mirror drawing in the psychotherapy of schizophrenic patients with

disturbances in verbal language, Journal of the American Academy of Psychoanalysis,

26(1), 109-122, 1998] that the patient and therapist reveal the patients unconscious, but

also that the patient reveals the analysts unconscious, so that in the method, the progressive

mirror drawing, there is a mirroring. When I copy the drawing of the patient, I change

something, so I discover the unconscious of the patient, but when the patient copies my

drawing and changes it, he gives an interpretation and discovers my unconscious. In this

sense, I agree with what Dr. Benedetti has said.

BK: Mutuality?

MP: It broadens the awareness of the therapist.

BK: By putting yourself more into the therapy and making an addition to their drawing, thereby

revealing parts of yourself that you may not be aware of at the time, you are allowing

yourself to be vulnerable. Perhaps this allows the patient, through identification with the

therapist, to soften some of what Herbert Rosenfeld called destructive narcissism, the

patients idealization of a solipsistic counter-dependency, protective insulation of the self,

and attacks on the libidinal parts of the self and other.

MP: The idea of the line as part of the self when it appears in the drawing.

BK: The symbiotic self?

MP: Yes. It can appear in my drawing or in the patients drawing but it is common.

JK: By common, you mean like a shared unconscious?

MP: Yes, in the symbiotic sense.

JK: Common to this pair or humans in general?

MP: To this pair.

[At this point in the interview, there ensued a discussion between Drs. Benedetti, Peciccia and Julie

Kipp of group treatment, supervision of the trainee therapists and milieu treatment in general.]

GB: Dr. Koehler, another question you asked, How do you understand such symptoms as

auditory hallucinations, delusions, as well as the more negative symptoms such as alogia,

anergia, etc.? Negative symptoms express the breakdown of the exhausted psychotic ego,

the loss of its resources, the widening of the chronic schizophrenic existence. Their

psychotherapy needs the mild and slow stimulation of the still present resources as well as

the possibility of nourishing the patients ego by means of a constant, reliable, but not too

much active countertransference. Negative symptoms may also be defences against every

form of activity by severely injured patients. So-called productive symptoms, the

positive symptoms, indicate the impact of split-off parts of the patients self, which cannot

be repressed by the weak psychotic ego into the unconscious and which therefore appear to

the patient as events of the outer world, as the activity of persecutors, etc. It is possible that

the therapist introjects the split-off feelings and drives of the patient in order to transform

them into positive symbols, to humanize them and to give them back to the patient in a new

form, through a dream, or a drawing or a phantasy.

BK: That is what you mean by the creative variant of Herbert Rosenfelds projective

identification?

GB: Yes.

BK: Its the rotated side of the paranoid projective identification. Bions concept of

container/contained and reverie come to mind. By the way, it is in the phase of therapeutic

symbiosis that Searles believed was the phase in which you can more effectively interpret

these negative, paranoid transferences. Searles saw the phase of pathological symbiosis as a

defense against hate and fear emerging as a result of the growing closeness in the

therapeutic dyad in which the hate is displaced against the world. Underlying that hate,

Searles believed, is this need for a more therapeutic symbiosis, a need for a less paranoid,
 emotional oneness between the therapeutic partners which does not threaten the integrity of

each.

GB: I am not sure when [to interpret these transferences] but I would say if the patient is

destructive he is at the same time self-destructive. If we interpret it, the patient becomes

hopeless. The best interpretation is to sustain, to have the strength to sustain his

destructiveness, conveying to the patient the feeling that the therapist is strong enough to

accept this [similar to Winnicotts idea of the therapist surviving the phase of maximum

destructiveness, i.e., by the therapist not retaliating or abandoning the patient and thereby

creating a firmer sense of subjectivity and externality]. Later on, if the patient can

distinguish a part of the self which does not hate, then interpretation of the hate and

destructiveness is important because the patient learns to separate himself from that part of

the destructive tendencies.

MP: I was thinking about the positive and negative symptoms and Margaret Mahlers theory of

the psychoses the trauma at the oral stage and lack of distinction between baby and

mother. However, it was difficult to explain the autistic symptoms. The idea was that the

symbiosis was the trauma. Mahler distinguished between the autistic and symbiotic

psychoses in order to explain the negative and positive symptoms, but it is not clear why

some patients very rapidly move from autistic, negative symptoms to productive, positive

symptoms. This led us to think that the symbiotic self and autistic self are not integrated in

schizophrenia. Sometimes the autistic self prevails and we see negative symptoms and

sometimes prevails the symbiotic self and we have productive symptomatology. [See G.

Benedetti and M. Pecicca (1994). Psychodynamic reflections on the delusion of

persecution, Nordic Journal of Psychiatry, 48, 391-396 and M. Pecicca and G. Benedetti

(1996). The splitting between separate and symbiotic states of the self in the

psychodynamics of schizophrenia, International Forum of Psychoanalysis, 5, 23-38.] In

the autistic closure the negative symptoms are a way to strengthen the boundaries with the

outer world in a very hard way, nothing penetrates the psychic skin and the symbiotic

symptomatology is the opposite.

BK: Permeability.

MP: Invasion from and fusion with the outside world.

BK: What causes this lack of integration between the separate and symbiotic selves? Why are

schizophrenic patients not integrated at this level?

GB: It is easier to describe this deintegration than to find out the way. Dr. Peciccia used the

analogy with light an integration of waves [symbiotic self] and particles [separate self].

So it is with relationships. There is the early symbiotic self which becomes unconscious

but which is the source of art, poetry, intuition and the separate self which permits us to

distinguish individuals. Maybe some patients grow up in some families in which the

symbiotic needs are too strong. Another possibility is the biological constitution of the

patient. I cannot deny that some roots of this constitution are biological. Could you answer

this question, Dr. Peciccia about the deintegration of the separate and symbiotic selves in the

patient. What is the source of schizophrenia?

MP: We can create a model, but it is a creation, we must be aware it is a creation. The infants

self, at the very beginning, grew up in two different areas in the inner space of the separate

baby and in the mothers space. We could hypothesize that there is an oscillation of the

infants self from the separate space to the self-space of the mother, himself in the mother.

This oscillation could be good and positive or it could be negative. What I mean is that if

we think that the baby has the need of the mother while in the separate self-state, the need

for the breast and so forth, this pushes him to search for the mother. If the mother is there

and answers that need, he finds himself in the symbiotic self in the mother in a positive way.

This is a good oscillation, transition from separate self to symbiotic self. If the mother is

not there, or if there is severe frustration, then the experience of the symbiotic self is

threatening, and then it happens to be a negative one.

BK: So the focus is on transitions of self-states, from separate to symbiotic selves. Searles has a

very important conception of what may make this symbiotic experience between mother and

infant so threatening and frustrating. He believed that at times the mother or father is not

there, so as to protect the child from her or his own symbiotic libidinal needs which are
 experienced as destructive. He thought that one reason why the work took so long in the

psychotherapy of chronic schizophrenia, is that both therapist and patient defend against the

growing emotional closeness which threatens on an unconscious level, the destruction of

each participants sense of self and identity. Recently, when I spoke with Searles about

these issues, he noted that when families were more actively involved in the

psychotherapeutic work conducted at the now closed Chestnut Lodge Hospital in Rockville,

Maryland, clinicians achieved better results.

BK: How do you define Therapeutic Images, Transitional Subject and the use of Dreams in the

therapy?

GB: In my efforts to focus the concept, I have decided to make use of the metaphor,

transforming images. I would like to start off by saying that, at any point of our

psychological efforts, whether in individual, family or group therapy, it is the germination

within the therapist of transforming images which shifts the sad, oppressive, delirious,

anxiety-provoking images seen by the patient. And it is by taking notice of these negative

images, not by contradicting them, but by extending them towards new horizons, that a

common thread can be woven in the psychotherapy, a push towards the positivization of

the psychotic experience; towards the progression of the psychopathology, the creation

of transitional subjects between us and the patient.

Therapeutic transforming images, as I see them, derive from our ability to identify

ourselves with the catastrophes occurring within the patient, to live them as if they were,

in a way, our own perhaps even dreaming about them at times; they derive from our ability

to absorb the patient into ourselves, to the point that our latent psychotic nuclei are

mobilized to some extent. These nuclei then lose all their power to harm us, precisely

because they are now part of the dialogic interweave. This is how the patient enriches our

minds with symbolic images, while he thinks he is exhausting our energies, and how we can

restore to him what he has awakened in our unconscious. Our absorbing of the sick

person, which must precede the transformation process, amounts to the act of internalizing

the split, cut off and negativized parts of him. This absorption, which may manifest itself (at
 certain stages of the therapy) in the therapists dreams about death, enables the patient to

gain a therapeutic awareness of the positive parts of himself, which would otherwise be

completely buried by the ngative aspects. It is from these parts that the therapist forms a

virtual image of the oneness of the patient, which is then continuously projected onto him, as

a transforming image. There is perhaps nothing so stubborn as the resistance the

schizophrenic puts up against therapeutical positivization. It is as if the persecutor within

him would not permit it at any price; and indeed, at times it is possible to positivize the

patient only through the time and space we share with him. The positivizing image cannot,

therefore, reach the patient unless we provide the vehicle for it, by concentrating on it in his

presence.

BK: Have you had the experience of seeing this as patients recover?

GB: Yes, this is a great and moving experience, as well in the treatment of an acute psychosis,

where suddenly, even during a therapeutic session, the psychotic self-identity changes, as

in the slow development of chronic schizophrenics, where creative possibilities of the

patients lie not side by side with their psychotic symptoms, but are extracted from the very

core of the symptoms themselves, as the patients recover.

I am afraid I must leave you now as I must prepare for my lecture.

[Professor Benedetti had to leave to prepare for his address to the 13th ISPS Congress

held in Stavanger, Norway, 2000]

References

Benedetti, G. (1987). Psychotherapy of Schizophrenia. New York: New York University Press.

Benedetti, G. (1972). The psychotherapy of psychotic and schizophrenic patients and factors
facilitating them. In P. Bori (Ed.), USA-Europe Conference on Facilitating Climate for the
Therapeutic Relation in Mental Health Services, ARS, Perugia, Italy.

Benedetti, G. (1987). Illuminations of the human condition in the encounter with the psychotic
patient. In G. Benedetti (1987), Psychotherapy of Schizophrenia,, pp. 129-138, and in J. L.
Sacksteder, D. P. Schwartz, and Y. Akabane (Eds.), Attachment and the Therpeutic Process: Essays
in Honor of Otto Allen Will, Jr., M.D., pp. 185-196. Madison, CT: International Universities Press.
Benedetti, G., and Peciccia, M. (1994). Psychodynamic reflections on the delusion of persecution.
Nordic Journal of Psychiatry, 48, pp. 391-396.

Lacan, J. (1966). Ecrits. Editions due Seuil, Paris.

Peciccia, M., and Benedetti, G. (1996). The splitting between separate and symbiotic states of the
self in the psychodynamics of schizophrenia. International Forum of Psychoanalysis, 5, pp. 23-38.

Peciccia, M., and Benedetti, G. (1998). The integration of sensorial channels through progressive
mirror drawing in the psychotherapy of schizophrenic patients with disturbances in verbal language.
Journal of the American Academy of Psychoanalysis, 26(1), pp. 109-122.

Searles, H.F. (1979). Countertransference and Related Subjects: Selected Papers. New York:
International Universities Press.

Brian Koehler, Ph.D.

80 East 11th Street, Room 339
New York, NY 10003
212.533.5687
brian_koehler@psychoanalysis.net