Bodenheimer A R
Schweiz Arch Neurol Neurochir Psychiatr. 1978;122(2):213-35.
It is not the diagnostic evaluation but merely the phase in which we find our patient, that determines about the process of psychotherapy with schizophrenic patients. There are three phases--or, more approximately, four phases (phase one to three plus "phase zero")--to be differentiated: Phase Zero: This phase precedes an obvious clinical appearance of psychosis. Patients feel ridiculous in their anxiety and are not yet capable to create the symptomatology of psychosis.--Intensive participation in those strange perceptions and the attempt to witness the same experiences as the patient does, often help to prevent the formation of a severe psychosis. Phase One: Deep psychosis with common symptomatology. Verbal communication in the usual form is no more possible. Only answering the patient in his own language--speaking as he speaks and behaving as he does--helps to overcome his permanent isolation. Phase Two: Stage where the patient leaves his psychotic world and does not yet live in the world of his "healthy" surroundings.--In this phase psychotherapy intends to lead towards a confrontation with the previous psychotic experiences in order to integrate them into his personality. Phase Three: Phase of return towards a more adequate behaviour.--In this phase the therapist helps his patient to build up his "narcissistic coat" in order to create a shelter, where he can retreat; out of this "cocoon" he is able to observe what happens around him, without being thrown back into a severe psychotic crisis. On the other hand there may arise situations of "relapses" (so-called intermediary stages). These phases, which resemble common depression, can be understood as substitutes of the former psychotic situation. It is insight in its uttermost distinction that leads to secondary stages. Therefore psychotherapy will be most helpful, when the understanding of the circumstances that lead to such situations, is not evaded but promoted; the more intensely these promotions, the better the prognosis.
决定精神分裂症患者心理治疗进程的并非诊断评估，而仅仅是我们发现患者时所处的阶段。有三个阶段——或者更确切地说，四个阶段（第一阶段至第三阶段加“零阶段”）需要区分：零阶段：此阶段先于精神病明显的临床表现。患者在焦虑中感到荒谬，尚不具备产生精神病症状的能力。——深入参与那些奇怪的感知，并尝试像患者一样见证相同的经历，通常有助于预防严重精神病的形成。第一阶段：伴有常见症状的深度精神病。以通常形式进行言语交流已不再可能。只有用患者自己的语言回应他——像他那样说话、像他那样行事——才能帮助克服他长期的孤立状态。第二阶段：患者离开其精神病世界但尚未生活在“健康”周围环境世界的阶段。——在这个阶段，心理治疗旨在引导患者面对先前的精神病经历，以便将它们融入其人格。第三阶段：回归更适当行为的阶段。——在这个阶段，治疗师帮助患者建立他的“自恋外衣”，以便创造一个他可以退缩的庇护所；从这个“茧”中，他能够观察周围发生的事情，而不会被抛回严重的精神病危机中。另一方面，可能会出现“复发”情况（所谓的中间阶段）。这些类似于常见抑郁症的阶段，可以被理解为先前精神病状况的替代物。正是最彻底的洞察力导致了继发性阶段。因此，当不回避而是促进对导致此类情况的环境的理解时，心理治疗将最有帮助；这些促进越强烈，预后就越好。
