44185226 Psychotherapy of Schizoid Process

PSYCHOTHERAPY OF SCHIZOID PROCESS by Gary Yontef

Transactional Analysis Journal, Vol. 31, No. 1, January 2001 7

Psychotherapy of Schizoid ProcessGary Yontef

AbstractSchizoid process is one of the most ubiq-

uitous personality patterns, but it is insuffi-ciently discussed in the literature. This ar-ticle offers a description of both the trueschizoid and the more prevalent schizoidprocess that runs through various types andlevels of functioning. Schizoid process andpersonality type are described, includingthecharacterological organization, interper-sonal processes, and developmental originsof schizoid process. Therapy of schizoidprocess is discussed in terms of presentationof the schizoid in psychotherapy, develop-ment of the therapeutic relationship, stagesof therapy, and treatment suggestions andcautions.

The schizoid process is important enough towarrant more attention than it currently re-ceives, partly because, to some degree, every-one experiences some facets of it. Discussionsabout the schizoid process can clarify issuesrelated to contact, isolation, and intimacy inrelation to people with a variety of characterstyles who operate at levels of personal func-tioning ranging from normal neurosis throughserious character disorders.

True schizoids are also fairly common.These are individuals for whom the schizoidprocess is central to their dynamics and who fitthe DSM-IV (American Psychiatric Associa-tion, 1994) diagnostic criteria. They tend to bequiet patients who do not cause much troubleor make many demands. If the therapist doesnot know about the schizoid process and howto work with it, such clients may well be intherapy for a long time without really dealingwith their most basic issues.

This article is a modified version of a keynote addressgiven on 20 August 1999 at the annual conference of theInternational Transactional Analysis Association in SanFrancisco.

In this article I use the term "schizoid" to re-fer both to the true schizoid and to the patientwho functions with significant schizoid pro-cesses or defenses but does not fit the fulldiagnostic picture.

Presenting Picture of the True SchizoidThe true schizoid usually presents as a loner,

someone who is profoundly emotionally iso-lated, who has few close friends, who is notvery close even in "intimate" relationships,who drifts through life, and for whom lifeseems boring or meaningless. Schizoid patientsusually show extreme approach-avoidance dif-ficulties. They often come to therapy becauseof loss or threat of loss of a relationship or be-cause of relationship difficulties at work. Theyfrequently describe themselves as depressedand tend to identify more with the spaces be-tween people than with interhuman connec-tions. In therapy, as in many of their relation-ships, they tend to be present but not withvitalitythat is, not "in their body" or withtheir feelings.

Schizoid patients tend to come to therapyregularly but do not appear to be engaged emo-tionally. A common reaction of the therapist inresponse to a schizoid patient is to becomesleepy, even if he or she does not have thisreaction with other patients. There is so littlehuman connection during sessions that it is likenot having enough oxygen in the room. Thefirst time this happened to me was with apatient I liked. I thought perhaps I was gettingsleepy because 1 saw her right after lunch, so 1changed her hour. But that was not the prob-lem. In fact, 1 never get sleepy with patientsexcept occasionally with a schizoid patient.

The Existential Terror UnderneathTo people with schizoid character organiza-

tion, real human connections are terrifying. Intheir fantasy life and their behavior, theseindividuals try to live as if in a castle on an



island where they are totally safe. The mainfeature of this isolation is a denial of attach-ment and the need for other people. Of course,living that way brings on another terrortheterror of not being humanly connected. If theirtendency to defend themselves by isolatingwere to be fully realized, they would not beconnected enough to maintain a healthy ego.

Schizoid individuals have to struggle tomaintain their human existence as individualpersons. The human sense of self and good egofunctioning cannot develop and be sustainedwithout interpersonal engagement, but schizoidisolating defenses attenuate the interpersonalbond to the point of endangering ego develop-ment and maintenance. Often schizoid peoplewill create in their fantasy life the satisfactionor safety they lack in their experienced inter-personal world. They also have human connec-tions in safe contexts (e.g., at a geographicaldistance), and disguised longings are oftenfound at a symbolic level (e.g., in dreams anddaydreams). One frequent symbolic wish is toreturn to the womb, which is seen as a state ofoneness and safety. But, if that were possible,it would make sustained human identity impos-sible since it would exclude interpersonal con-tact.Contact and Contact Boundaries

To understand the importance of the schiz-oid process in all human functioning, we needto consider the concepts of contact and contactboundaries. Contact is the process of experien-tial and behavioral connecting and separatingbetween a person and other aspects of his orher life field. The contact boundary has thedual functions of connecting and separating theperson and his or her environment (includingother people), just as a fence has the dual func-tion of connecting and separating two proper-ties. These dual functions involve movementalong a continuum between the two poles orfunctions of connecting and separating.

The connecting process involves a closing ofthe distance between people, a receptiveness oropenness to the outsideand especially toother peoplewith the boundary becoming po-rous so that one takes in from and puts out to

others. The separating process involves in- creasing distance, closing off the boundary, be-ing alone and not taking in, with the boundarybecoming less porous and closed to exchange;at the extreme, the boundary becomes closed,like a wall. People need both connecting andseparating.

All living creatures need to connect withtheir environment to grow. Just as we can onlysurvive physically by taking in air and waterfrom the environment, human psychologicaldevelopment and maintenance also requiresconnection with the environment, especiallywith other people. People can only grow andflourish by connecting to the interhuman en-vironment.

At the extreme end of the connection pole ismerger, enmeshment, and a loss of separate ex-istence, will, need, and responsibility; such to-tal connection means death by merger, a disap-pearance of autonomous existence. Physicallyit means merger with the environment; psycho-logically is means a loss of individuation andseparate existence. Human existence requiressome degree of experienced separation fromthe environment.

So we see that oneness can be healthy or un-healthy, just as separating can be. Intimacy isa healthy form of oneness, whereas a spiritualretreat is a healthy example of separation fromordinary contact. Ideally, the movement be-tween contact and withdrawal is governed byemerging need. We become lonely, we need toconnect; we move into intimacy, momentaryconfluence, or ongoing commitment. Then wemove away from connecting with the other tobe with self, to rest s.nd recover, to center, or tofind serenity. Thus we connect to the point ofsatisfaction of need, then change focus accord-ing to a new emerging need. We separate froma particular contact when withdrawal or differ-ent contact is needed. However, in health, aperson withdraws from contact while sustain-ing a background sense of self connected withother people and the universe.

This flexible movement between close con-nection and separation preserves the sense ofbeing humanly connected. It is unhealthy whenthis flexibility is lost and either separation or



connection becomes static because movementin and out of contact according to need is di-minished or restricted. At one unhealthy ex-treme the individual separates and isolates tothe point of losing a sense of being humanlybonded. Isolating in this way and to this degreeis crucial to understanding the schizoid pro-cess. For schizoids, the process of separatingwith underlying connectedness and connectingwhile maintaining autonomy is foreign. Theirlives are marked by the profoundly frighteningand disturbing fact of separating without main-taining a sense of emotional connectedness andwithout a developed ability to connect again.They do not connect to others with much hopeof being met and lovingly received. Schizoidsdo not believe they can be loved, and they fearthat even if a relationship is established, the in-timate connection means losing autonomy ofself and other. Even feeling the need to con-nect would, in either case, be painful and/orfrightening.

It is dangerous to move into intimate connec-tion if you cannot separate when needed. Ifyou think you are going to be caught up, de-voured, or captured in the connection, it is ter-rifying to move into intimate contact. On theother hand, if you do not feel connected withother people, especially if you do not believeyou can intimately connect again, the separa-tion or isolation is both painful and terrifying.

Without movement one is fixed, stuck, stag-nant, and unable to grow. Being stuck in anyposition on the continuum of connection andseparationwhich is the case when the schiz-oid process is operatinginvolves a degree ofdysfunction, with some needs not being met.Being stuck in an isolated position, a con-nected position, or a middle position betweenintimacy and isolation are all problematic.

Being fixed in a middle position is commonin the schizoid process: The person is neithertruly alone nor truly with another. This immov-able position between connecting and separat-ing is a compromise to avoid the terror of be-ing completely alone in the universe, on theone hand, or of being threatened by engulf-ment, enmeshment, attack, and rejection, onthe other.

Twin Existential FearsThe typical childhood of the schizoid patient

is marked by the experience of too much or toolittle human connection. Too little refers to alack of warmth and connectedness and a senseof emotional abandonment; too much refers tointrusive parenting that emotionally overridesthe capability of the infant or young child andcauses him or her to isolate or dissociate tosurvive. Sometimes the abandonment and in-trusion alternate.

Given what we know about the importanceof flexible movement between connecting andseparating for the growth and well-being of theindividual, it is easy to understand how thetypical childhood experiences of the schizoidleave him or her with deep-seated, often un-conscious feelings of merger-hunger, on theone hand, and simultaneous fear of entrapmentand suffocation on the other. These lead to uni-versal twin fears that are fundamental to theschizoid process: the panic or terror of contactengulfment/entrapment and the panic or terrorof isolation. These are particularly intense andcompelling for the schizoid, who experiencesthem at the existential level of survival ordeath.

Because the schizoid splits connecting anddisconnecting, thus losing easy movement be-tween them, he or she is faced with the threatof becoming stuck at one pole or the other.Therefore, schizoids think of relationshipsmostly in terms of potential for entrapment,suffocation, and bondage. They do not trustthat they will not devour the significant otheror be devoured. They do not believe that sepa-ration will happen as needed, and thus they donot feel safe to be intimately connected. Ofcourse, the danger of entrapment comes inlarge part from their own hunger for onenessand fear of abandonment, and the connectionbetween their own merger-hunger and the fearof entrapment is mostly not in their consciousawareness.

Many schizoid patients start treatment withthe expectation that they will be devoured orabandoned in therapy. Although they may beconscious of this fear early in the process, theextent of the dual fears and the connection to



their merger-hunger is usually not in awarenessuntil much later. Until then the denial of bothattachment and the need for intimacy predomi-nates. Their own merger-hunger is projectedonto others as a way of avoiding the awarenessby attributing it to someone else. Sometimesthese anticipations or perceptions are a projec-tion, although they can also be accurate.

Total isolation or abandonment is like death,especially for the young child. Part of theschizoid process is terroralthough not neces-sarily consciousof a triple isolation: isolationfrom others, isolation of the core self from theattacking self, and isolation within the coreself. A significant part of the schizoid processis a splitting between attacking selves and coreselves. At a deeper level there is also a kind ofisolation between aspects of the core self. Ingestalt theory this is conceptualized as aboundary between parts of the self that inter-feres with the boundary between self andother.

Experiencing the self in a vacuum meansloss of the sense of self as a living person. Theresulting loneliness is profound. It is real prog-ress in therapy when the true schizoid patientis able to experience loneliness and the desirefor connection.

The Schizoid Compromise: The In-and-OutProgram

One solution to the problem of avoidingcomplete deadness of self from lack of humanconnection while also avoiding the threat toexistence and continuity of self from intimatecontact is what Guntrip (1969) called "theschizoid compromise" (pp. 58-66). This refersto not being in but also not being out of en-gagement with other persons or situations. Animage that I think I borrowed from Guntripseems apt here: "How do porcupines makelove? Very carefully." There are several com-mon "very careful" patterns of the schizoidcompromise.

For example, a writer is too lonely to writein his apartment, so he goes to a coffee shopwith his laptop computer and manuscript.There he is not really connected with anybody,especially since he does not give out signals

that he wants to talk to anyone, but he is notalone either.

Another example is a man from Los Angeleswho has a relationship with a woman who livesin New York City. He can have a weekendconnection without the risk of losing himselfor being trapped in the relationship. WhenMonday morning comes, he will be thousandsof miles away in Los Angeles again while shestays in New York.

Another type of schizoid compromise in-volves the person repeatedly pulling out of re-lationships before making a commitment. Suchindividuals go through a series of relationships,always finding a reason why they cannot con-tinue. A similar pattern is having multiple lov-ers at the same time; the person engages onepart of the self with one partner and anotherpart of the self with someone else. One typicalconfiguration is having a sexual relationshipwith a lover, but without companionship andbuilding a life together, while maintaining aprimary but nonsexual relationship with aspouse. Sometimes individuals who show thispattern will say something like, "Gee, whycan't 1 get this together?" or ask "Why can't Iget a woman who has both?"

Such patterns illustrate a core pattern: theschizoid is impelled into relationship by needand driven out by fear. When faced with some-one with whom they might be intimate, theyfind it both exciting and frightening. They areafraid that they will devour their lovers withtheir need or that the lover will be devouring,deserting, or intrusive. They might lose theirindividuality by overdependence and merger-hunger or lose the relationship by being toomuch, too toxic, or too needy.

The solution to these dilemmas is Guntrip'sschizoid compromiseto remain half in andhalf out of the relationship, whether in theform of marriage without intimacy, serial mo-nogamy, or two lovers at the same time. Needsand fears will often be either denied or ac-knowledged in an intellectualized manner.Frequently such individuals will oscillate be-tween longing for the intimate other and reject-ing him or her, or they may stay in a stablehalfway position not able to commit to being



fully in the relationship or discontinuing it.They are tempted repeatedly to leave the rela-tionship and live in a detached manner, but of-ten they return again and again.

When touched emotionally or feeling inti-mate, the schizoid may become annoyed,scared, fault finding, and disinterested. Mean-ingful contact with another leads to crisis, andcrisis leads to abolishing the relationship. Theycannot live fully with the other, but they cannotlive without the other either. Being with threat-ens death-level confluence; being alone threat-ens death-level isolation. So the schizoid livessuspended between his or her internal worldand the external world without full connectionwith either. Suspended in the death-level con-flict between total isolation and being swal-lowed up, these individuals often feel tired oflife and the urge for temporary death. This isnot active suicide, just exhaustion from livinga life with insufficient nourishment.

Themes in TherapyThe discussion so far points out the major

themes that emerge in therapy with schizoidindividuals: isolating tendencies, denial of at-tachment, themes of alienation, and feelings offutility.

Isolating tendencies. Since being closecauses schizoids to feel claustrophobic, smoth-ered, possessed, and stifled, they often turninward and away from others. Thus commit-ment to relationship is very hard. They treattheir internal world as real and the externalworld as not real. They often have a rich fan-tasy life and tepid affective contact with others.In isolation they often fantasize about mergeror confluence as something to be longed for orto feel panicked aboutor both. In actual orfantasy contact they fantasize about isolationeither as a positive way of getting their ownspace or as something terrifyingor both.Schizoids manipulate themselves more thanthey interact with the environment.

Such individuals usually appear detached,solitary, distant, undemonstrative, and cold("cold fish"). They do not seem to enjoy muchand have few if any friends. They appear tolive inside a shell, and in most relationships

(including in therapy), those with whom theyare relating have the sense of being shut outwhile the schizoid is shut in, cut off, and out oftouch.

What is not always obvious with these in-dividuals is that they still have a capacity forwarmth, in spite of the schizoid process. Thismay come out in various ways, for example,with pets but not with people. 1 remember oneschizoid woman who said that "the only people1 trust are dogs," which she did not mean as ajoke. With such patients the therapist needs tobe sensitive to subtle shifts in order to pick upand gauge emotional reactions. This is espe-cially true since schizoids often show a lowlevel of manifest interest and affective energy,appearing to be absent minded and mentallyhalf listening.

Most often schizoids will express a desire tobe free of any impingement or requirement todo anything. In a relationship they will oftentalk about how they want to be able to go outand not have to face any limitations. At thesetimes the desire to connect is usually out ofawareness.

However, the schizoid process involvesmore than the simple isolating behavior of ashy or anxious person, more than social anxi-ety, obsessive compulsive behavior, or intellec-tualizing, although a schizoid character patternmay underlie any of these other isolating pat-terns. The issues of the schizoid involve life-threatening levels of existential vulnerability.Because this profound vulnerability makes therelationship with the therapist deeply terrify-ing, it takes a long time for the therapeutic rela-tionship, including trust, to develop.

It should be noted that the cognitive descrip-tions in this article provide a kind of a map forthe therapist, but one that only points the wayto work at a feeling level. Awareness andworking through with these individuals re-quires developing a trusting relationship; nofundamental change can happen with the schiz-oid on a purely cognitive basis.

Denial of attachment. For children who laterbecome schizoid adults, one way of copingwith a world that is too big, menacing, intru-sive, unresponsive, and/or abandoning is to



deny any need, weakness, and dependency andto promote the illusion of self-sufficiency.They learn to survive by living without feelingdependence, desire, need, or fear. The schizoidis especially trying to avoid burdening and kill-ing parents with his or her needs.

Schizoids avoid awareness of attachment invarious ways. The most common is splittingoff or disassociating from needs and feelingsthat are overwhelming. Conformity can also bea means of avoiding awareness of need andfear as can obsessive-compulsive self-mastery,addiction to duty, or service to others. One canavoid attachment needs by being regulated byrules and regulations rather than by vitalityaffect, or by conforming and serving, thusforming a false self that consists of a conven-tional, practical pseudo-adult who masks afrightened inner child.

Denial of attachment results in shallow re-lations with the world. Compulsive activity,compulsive talking, and compulsive service tocauses can all mask a shallowness of affectiveconnection. Some people who appear to beextroverted are actually schizoid in their under-lying character structure.

In the extreme, the schizoid's denial of at-tachment results in his or her being mechani-cal, cold, and flat to the point ofdepersonaliza-tion; the individual loses a sense of his or herown reality and experiences life as unreal anddream like. Of course, not all schizoids deper-sonalize to this extent.

Schizoids often may deflect the importanceor impact of praise and criticism as protectionagainst attack, disapproval, disappointment,and so on. Although they strive to feel andappear unaffected by praise and criticism, theyare actually sensitive, quick to feel unwanted,and suffer from a deep underlying shame (Lee& Wheeler, 1996; Yontef, 1993). Their self-representation is always a shameful sense ofself as being defective, toxic, and undesirable.They live internally as if they were alwaysdeserted because of their own defect. They areespecially contemptuous of their own "weak(needy) self."

When the need they have been denying startsto emerge into awareness, schizoids experience

intense shame. In fact, shame is a fundamentalprocess for schizoids. They are easily shamed,although that is not always obvious becausethey deny that they are attached or that theyneed anything. When they feel safe enough tostart exploring their shame, they manifest agreat deal of loathing for their needy self.However, if the therapy is confrontive (e.g., inthe way encounter groups and some confron-tive gestalt therapists used to be), demandsquick change, or is insensitive to issues ofshame, these feelings will not emerge becausethe patient will not experience the necessaryfundamental trust in the therapeutic relation-ship.

Themes of alienation. Schizoids feel so alie-nated and different from others that they canexperience themselves literally as alienas notbelonging in the human world. I have a patientfrom Argentina who quoted a saying in Span-ish that describes her experience: She feels likea "frog who's from another pond."

In their alienation, these individuals cannotimagine themselves in an intimate relationship.The people world seems strange and frighten-ing, even if also desirable. When they see cou-ples being intimate, they are often mystified:"How do they do that?" No matter how theyforce themselves to date or to meet new peo-ple, they cannot imagine themselves in a sus-tained intimate relationship. This leads to thefourth theme.

Feelings of/utility. The schizoid experiencesloneliness, futility, despair, and depression, al-though the latter is somewhat different fromneurotic, guilt-based depression. Both are com-prised ofdysphoric affects and an avoidance ofprimary emotions and full awareness. How-ever, neurotic depression has been described as"love made angry." That is, the depressed per-son feels angry at a loss followed by sadnessand broods darkly against the "hateful denier."This aggressive emotional energy then getsturned against the self.

In contrast, schizoid despair has been de-scribed as "love made hungry." The personexperiences a painful craving along with fearthat his or her own love is so destructive thathis or her need will devour the other. The



schizoid feels tantalized by the desire, madehungry, and driven to withdraw from the "de-sirable deserter." The deep, intense craving isno less painful because it is consciously re-nounced or denied.

In ordinary depression the person has asense of the self as being bad; usually he or shefeels guilty, horrible, and paralyzed. The schiz-oid, on the other hand, feels weak, depersonal-ized, like a nonentity or a nobody without aclear sense of self. Guntrip said that peoplemuch prefer to see themselves as bad ratherthan weak. They will typically refer to them-selves as depressed more readily than weak,bad rather than devitalized, futile, and weak.

Guntrip (1969) called the depressive diagno-sis "man's greatest and most consistent self-deception" (p. 134). He went on to say thatpsychiatry has been slow to recognize "egoweakness," schizoid process, and shame. "Itmay be that we ourselves would rather not beforced to see it too clearly lest we should finda textbook in our own hearts" (p. 178). Fortu-nately, I think in the last few years there hasbeen a real opening in therapeutic circles torecognizing relationship and shame issuespresent in the therapist as well as in the patient(Hycner & Jacobs, 1995; Yontef, 1993).

Healthy DevelopmentThe self can only experience itself in the act

of experiencing something elseand beingexperienced. Cohesive, healthy self-formationdepends on contact with the mothering personthat is neither too little nor too much.

From birth, infants are equipped to be bothseparate from and connected with others.Stem's (1985) research confirmed that fromthe beginning infants know themselves andconnect with the human environment. For theirmaturational potential to develop, infants mustbe welcomed into the world and supported inbeing themselves and being connected. Thissupport starts with the mother restoring theconnection severed by birth. The infant needsto be made to feel that he or she belongs in theworld of people. Through a dependable motherand infant relationship, the infant leams that heor she is not emotionally alone in the world

even when physically separated. This supportfor connection and separation is neededthroughout infancy and toddlerhood.

Ideally, the infant/child leams that he or shecan be alone in the presence of the mother andthus in intimate relations with others. In thisway children learn that they can have privacyand self-possession without loss of the other,that they can be physically separate or havetheir own feelings and thoughts in the presenceof the parent and still feel connected and feelconnected-with when they have needs and feel-ings. The child can be alone in outer reality be-cause he or she is not alone in inner reality.The development of these capacities dependson early parental experience, the developmentof object constancy, and so forth.

Schizoid DevelopmentUnfortunately, the course just described is

quite unlike the early experience of the schiz-oid, whose childhood tends to be marked al-ternately by experiences of intrusion and beingoverwhelmed, on the one hand, and feelingempty and alone in the universe, on the other.The schizoid then uses worry, fantasy, and iso-lation to protect against these experiences.Although nature and mother arouse powerfulemotional needs in the child, if there are eitherinsufficient warm, loving responses or an ex-cess of intrusive, overwhelming responses, theneed only increases, and the child experiencespainful deprivation or unsafe feelings as wellas anxiety at separation and/or connection. Adeep intimacy-hunger grows in the child.

The schizoid's early experience is that moth-er is not reliable, usually because she is alter-natively intrusive and abandoning. Mother notonly cannot tolerate, contain, and guide thechild's affects (e.g., need, anger, exuberance,even love), she finds them threatening andoverwhelming and treats them as toxic. Thesemothers usually become overwhelmed becauseof their own depression, life situation, or char-acterological issues; often they do not have thesupport they need to meet the child in intensiveaffective states and to stay with him or heruntil the affect has run its course. Clearly, theproblem is with the mother, not with the child.



However, the infant or child's experience isthat his or her life forces and vitality appear tokill motheror at least the connection to andrelationship with mother. If a young child hasa tantrum and mother withdraws to her roomfor three days, the child's reality is that he orshe has emotionally killed mother. And, ofcourse, killing mother would make the infant'slife impossible as he or she cannot live withouta parent.

The legacy for the child is that his or her lifeforce threatens mother, which is equivalent tothe child experiencing that "my life threatensmy life." Anything from within, even some-thing good, turns bad and destructive with ex-posure. The only hope is to keep everythinginside and thus invisible. The child must, at allcosts, avoid causing total emotional abandon-ment by or intrusion and annihilating counter-attack from mother. Therefore, the child suf-fers isolating himself or herself to avoid aneven more devastating deprivationthe loss ofthe mother and the child's relationship withher. Unfortunately, this leaves the child with ahuge hunger that cannot be satisfied, a hungerthat is projected onto the mother, who is thenseen as devouring. And a mother who actuallydoes devour makes this even more real andfrightening.

Splitting the SelfAn important part of how the child copes

with this situation is by splitting the self.Survival is achieved by relating to the worldwith a partial self or "false self," one that is de-void of most significant affect and relates onthe basis of conforming to others' requirementsrather than on the basis oforganismic experi-ence. Guntrip (1969) used the phrase "the liv-ing heart fled" (p. 90) to describe the situationin which the vital energies, emotions, and vi-tality affects are held inside, leaving an emptyshell to interact with others and to direct hu-man relations.

This schizoid pattern creates external rela-tions that are not marked by warm, live, puls-ing feelings. Instead, when interpersonal nur-turance is available, schizoid individuals fear aloss of self from being smothered, trapped, or

devoured. When strong desire or need isaroused, they tend to break off the relationship.Hatred is often used to defend against lovewith its dangers and disappointments, a patternthat starts in early childhood.

However, what happens to the lively emo-tional energy that is held in? And how does theschizoid stay sufficiently related to people tosupport the survival of the self? One key pro-cess is the development of internal rather thaninterpersonal dialogues. Instead of someonewith a relatively cohesive sense of self interact-ing with others, there is a sense of self inwhich aspects of personality functioning aresplit off from each other. The most commonlyencountered manifestation of this in psycho-therapy is the split between an attacking selfand the "core" or "organismic" self. When theorganismic self shows characteristics of beingin need or emotional, the attacking self makesself-loathing, judgmental statements about be-ing "weak" or "needy." One might characterizethis as attacking and shaming the organismicself, which it calls the "weak self." The personoften identifies with the attacking self andthinks of his or her own love as so needy thatit is devouring and humiliating.

To the degree that the person's contact is be-tween parts of the self rather than a relativelyunified self in contact with the rest of theperson/environment field, the person is leftwith a deep and painful intimacy-hunger (oftendenied), dread, and isolation. The internal at-tack is usually not only on the self that isneedy, hungry, and weak, but also on the selfof passion and bondingeven happy passions.

Within the core self there is another split,which I will only consider briefly. This split isbetween the self (or the self-energy) that con-nects and fights with the attacking self and thecore energy that has an urge to isolate evenmore, to go back to the womb. The retreat fromthe internal self-attack is designed to protectthe core life energy, which is kept isolated inthe background to protect it. It is a fight forlife.

There are a couple of other things that occurbecause of this process that I have not yetmentioned. One is that, as part of schizoid



dynamics, cognitive processes are often used inthe service of feeling humanly connected whileremaining isolated rather than in preparationfor interpersonal contact.

Self-attack is an internal dualism that dividesthe person into at least two subselves. Whenthe self-attack is on the feeling self, it results inshame, humiliation, and psychological starva-tion. It creates the defect of a divided ratherthan unified self and makes the life energy(i.e., feelings) a sign of being defective. It cre-ates a sense that since I feel, want, and need,therefore I am unworthy of love and respect.So it is not surprising that schizoids oftenattempt to annihilate or master their feelings ofneed, sometimes in a sadomasochistic way. Forthem, self-attack is not directed toward their"doing"; it is an attack or attempted annihila-tion of the "being."

However, being and being-in-relation are in-separable. The sense of self only develops inrelationship, not in a vacuum. Feeling with andfeeling for other personsand being felt forby themis vital for a healthy sense of self.Shared emotional experience is a part of learn-ing to identify and identify with the self and toidentify with bonding with others. Because oftheir isolating and denial of attachment, schiz-oids often operate without a sense of beingthe empty shell experience. This "doing"without a sense of "being" leads to a sense thatbeing or life is meaningless. Schizoids usuallyfeel this way, although they often attribute it toa particular activity being meaningless ratherthan to their own process.

Even the core selfin reaction to the top-dog, critical selfis split. There is an engaged,contact-hungry core self that does battle withthe top-dog self, which can manifest in sado-masochistic and bondage and discipline fanta-sies. In contrast, the passive, isolating core selfis regressive and imagines going back to thewomb. It is this self that is in danger of losinghuman connectedness; it fears existential star-vation, loss of ego or sense of self, depersonal-ization, being alone in a vast, empty universe,even death. These fears can become knownduring quiet times, which may make calm,peace, quiet, sleep, or meditation frightening.

The unfinished business of schizoids, theirmost central life script issue, centers on thestruggle to make "bad introjects" into "goodintrojects." However, this usually does not suc-ceed easily. The bad introject usually staysrejecting, indifferent, and hostile until very latein therapy. While the therapist may think thatprogress is being made as some of these issuesare uncovered, the schizoid patient often expe-riences only intensified self-loathing. Frustra-tion and failure trigger the unfinished businessand the rest of this negative script, includingisolating defenses, retroflected anger and rage,strong defense of the negative sense of self,harsh self-attacks, and shame. It takes a greatdeal of patience and a long time to workthrough these issues.

Working with Schizoids and the SchizoidProcesses in Psychotherapy

The Paradoxical Theory of Change. Thegestalt concept of the paradoxical theory ofchange (Beisser, 1970) says that the more youtry to be who you are not, the more you staythe same. That is, true change involves know-ing, identifying with, and accepting yourself asyou are. Then one can experiment and trysomething new with an attitude of self-accep-tance. This contrasts with attempts to changethat are based on self-rejection or trying tomake yourself into someone you are not.

Working in the mode of the paradoxical the-ory of changes promotes self-support, self-recognition, and self-acceptance as well asgrowth from the present state by experimentingwith new behavior This experimentation canbe either the spontaneous result of self-recognition and self-acceptance or on the basisof systematic experimentation. The therapist'stask is to engage with the patient in a way thatis consistent with this paradoxical theory ofchange. With schizoids, this means engagingwith the patient at each moment and over timewithout being intrusive or abandoning, withoutsending the message that the patient must bedifferent based on demands or needs of thetherapist or the therapist's system. While manytherapists might endorse this in the abstract,often their nonverbal communication creates



pressure for the patient to change based on willpower, conformity, or as a direct result of thetherapist's interventions.

The Dialogic Therapeutic Relationship.Some of the principles guiding work from thisperspective are the characteristics of dialogueaccording to Buber's (I965a, 1965b, 1967;Hycner & Jacobs, 1995) existential theory.They include: inclusion, confirmation, pres-ence, and surrendering to what emerges in theinteraction.

Buber's (1965b, p. 81; 1967, p. 173) term"inclusion" is similar to the more commonterm "empathic engagement." Inclusion in-volves experiencing as fully as possible theworld as experienced by anotheralmost as ifyou could feel it within yourself, within yourown body. Buber (1965b) called this "imagin-ing the real" (p. 81), that is, confirming theother's reality as valid. Both inclusion and em-pathy involve approximation; however, inclu-sion calls for the therapist's more completeimagining of the other's experience than doesempathy. Inclusion is more than a cognitive,intellectual, or analytic exercise; it is an emo-tional, cognitive, and spiritual experience. Itinvolves coming to a boundary with the patientand joining with the patient's experience, butit also requires the therapist to remain aware ofhis or her separate identity and experience.This allows for deep empathy without conflu-ence or fusion.

Inclusion, or imagining the patient's reality,provides confirmation of the patient and his orher experienced existence. It involves accept-ing the patient and confirming his or her poten-tial for growth. Such confirmation does notoccur in the same way when the therapistneeds the patient to change and thus aims at aconclusion rather than meeting the patient withinclusion.

A dialogic approach requires genuine, unre-served communication in which the therapist ispresent as a personthat is, authentic, congru-ent, and transparentrather than as an icon ofseamless good functioning. The therapist can-not practice this kind of therapy and also becloaked in a psychological white coat. He orshe must be present by connecting with the

patient's feelings as well as by acknowledginghis or her own flaws, foibles, and mistakes.

The dialogic therapist must trust in and sur-render to what emerges from the interactionwith the patient rather than aiming at a presetgoal. This approach recognizes, centers on,tolerates, and stays with what is happening asthe therapist practices inclusion and thus fo-cuses on present experience and moment-to-moment, person-to-person contact. In a sense,progress is a by-product of a certain kind ofrelating and mindfulness rather than somethingthat is sought directly. The therapist relin-quishes control and allows himself or herself tobe changed by the dialogue just as the patientdoes. As a result, truth and growth emerge forboth.

Subtext. Attitudes are often communicatednot by the text of what the therapist says, butby the subtext or how things are said. Nonver-bal cues have an especially powerful influenceon schizoid patients, even if neither they northe therapist are consciously aware of them.For example, a gesture, tone, or glance will of-ten trigger a shame reaction in a patient with-out the therapist intending to do so and withouteither the therapist or the patient being awareof the process (Yontef, 1993). And even whenthis operation (i.e., the effect of the subtext) isin awareness, it may not be expressed or com-mented on.

Although they may appear to be distant andonly vaguely present, schizoid patients (andmany other patients as well) are exquisitelysensitive to nuances of abandonment, intru-sion, pressure, judgment, rejection, or pushingin fact, to any message or subtext that saysthey are not OK as they are. Such messages arenot only contrary to the paradoxical theory ofchange, but they also trigger unfinished busi-ness from painful childhood experiences ofrejection and/or intrusion.

Sometimes I have tried to encourage a pa-tient to feel better, to convince the self-loathingpatient that he or she is not loathsome. By do-ing so, I inadvertently sent the message that thepatient's feelings and sense of self were sopainful that 1 as a therapist could not toleratethem. This was a repeat of the message the



patient received from infancy: You are tooneedy, too much of a bother. When you as thetherapist have a view of the patient that is morepositive than he or she has, the thing that youhear the most from the patient is, "You don'tunderstand." 1 still hear that occasionally, andI have been working with these dynamics for along time. In such cases, good intentions createdisruptions in the contact between therapistand patient and an impediment to workingthrough. (For a poignant example of this pro-cess, see Hycner & Jacobs, 1995, p. 70.)

I find it agonizing when patients I like hatethemselves and describes themselves as loath-some, something totally contrary to how I andothers (e.g., group members) experience them.For example, I have a bright schizoid patientwho makes excellent comments in the group,comments that other patients appreciate andfrom which they benefit. But his self-descrip-tion is, "I'm stupid," which for him is an un-touchable reality. Attempts to induce him totake in the views of others and thus modify hisview of himself have proved predictably futile.When people say they like him, think he issmart, or appreciate his remarks, his responseis usually, "You don't understand." I eventu-ally said, in effect, "You're right, I don't un-derstand, your reality is that you are stupid."As 1 stopped fighting with him about his nega-tive sense of self, deeper work started. Insteadof pretense, I began to see more continuity ofthematic work.

In general, when the patient tells me that I donot understand, he or she is right. As the thera-pist you do not have to agree with the patient'sviewpoint, but it is important to realize the pa-tient's reality is as valid as the therapist's.Moreover, you cannot talk the patient out ofhis or her reality even if you believe it is ac-ceptable to do so. Rather, the task is to connectwith and tolerate the patient's experience sothat he or she can leam to tolerate itand thento grow beyond it according to the paradoxicaltheory of change.

The "friendly" message of persuasion is ac-tually an attempt to get the patient to changehis or her perception, belief, experiencethatis, to be different. If the patient is in despair,

and the therapist works to get the patient not tofeel despair, whose need is being servedthepatient's or the therapist's? Can the therapiststand to stay in emotional contact as the patientexperiences despair, depression, hopelessness,shame, and self-loathing? If the therapist can-not or will not stay with the patient's experi-ence, he or she gives the patient the messageonce more that the patient's experience is toomuch to bear. This is like demanding a falseself, and it triggers shame and reinforces thechildhood script.

The most important thing the therapist cando with schizoid patients is to work patientlyand consistently to inquire about and focus onthe patient's experience, on what it is like tolive life with the subjective reality of being stu-pid and loathsome. This approach is most use-ful when combined with careful attention tosubtle signs of disruptions in the contact be-tween therapist and patient. Although schizoidpatients will not tell you about them, you cansee subtle signs of connection and disconnec-tion if you are observant. Often the latter in-dicate that subtext (nonverbal signs from thetherapist) have triggered a shame reaction. Thisis rich material if the therapist is willing to takethe initiative to explore it.

The same holds true when the patient has adifferent view of you, the therapist, than youhave of yourself. If you honor the patient'sexperience as one valid reality, not the reality,you can explore the discrepancy between your"reality" and the patient's "reality" and thus beconsistent with the principles of dialogue, phe-nomenology, and the paradoxical theory ofchange. Working with this attitude offersgrowth for both patient and therapist.

Techniques: Schizoid patients are amenableto creative approaches that center on theirexperience, on contact, and on what emergesin the therapeutic relationship rather than onprograms that try to get the patient some-where. This can be maximized by identifyingschizoid themes as they emerge rather thantrying to formulate them according to a presetplan. If you show interest and inquire about thethemes as they emerge, you do not need elabo-rate formulations to explain to the patient



about his or her process or life script. Insightwill emerge from the interaction when thetherapist follows these basic principles. Al-though this may seem to take a long time, inthe end it is more effective, safer, and nolengthier than approaches that appear to obtaina quicker cognitive understanding.

Working throughthat is, destructuring andintegrating core processesrequires identify-ing and staying with feelings as the patientexplores his or her experience. It involvesfeeling the affect and is, of necessity, morethan cognitive and/or verbal. The therapistmust be able to experience with the patient thefeeling of the empty shell, the core self, andthe critic and to work with these feelings asthey emerge and naturally evolve. It meansfeeling the inner child's painful hunger, terror,and need for the defense and how, when, andwhy it worked. It means feeling the experienceof being an alien. Such working through re-quires more intensive work over time than ther-apy that is only palliative. Any cognitive iden-tification of a theme before the patient can feelit is, at best, preparatory for deeper work, workbased on the patients felt sense of self andothers. An interpretation is only valid when itis confirmed by the patient's felt sense of it. Acognitive identification before the patient canfeel it lacks the patient's felt sense as a meansof confirming or disconfirming the therapist'sinterpretations. The cognitive focus is often abarrier to deeper work based on a felt sense.

The schizoid needs the therapist to be able tocontact the hidden core self without being in-trusive. This requires much sensitivity andawareness of the process so that openings canbe found where the therapist and patient candiscover a way to symbolize the very young,primitive, preverbal sentiment of the inner coreself. It also requires that the therapist be will-ing and able to admit errors and counter-trans-ference so that breaches in the therapist-patientrelationship can be healed.

A woman who wants to marry and raise afamily but who relates to men using the schiz-oid compromise is not likely to benefit fromeither an emphasis on contact skills and rela-tionship discussions that prematurely consider

themes before they emerge in the therapy or atherapy in which the therapist does not under-stand the schizoid process. A man who says hewants intimacy but is always unavailable, cri-tical, busy, or too impatient is in the same pre-dicament. Treatment must proceed step by stepby exploring issues as they emerge with atherapist who is informed by an understandingof the schizoid process.

For example, a man in a relationship keepsasserting that he wants his freedom. Inquiryand mental experiments start to clarify the sit-uation. He is asked to describe in detail whathappens when he is at home and to imaginewhat he would do if he were free. What emer-ges is a relationship pattern in which there isno movement into intimate contact and nomovement to separate while maintaining thesense of emotional bonding. This eventuallylinks to early childhood experiences of beingemotionally isolated within a troubled family,with freedom only coming by being away fromthe warring family situation. These isolatingdefenses were necessary in childhood, but sub-sequent exploration led the patient to discoverother solutions for himself as an adult.

For most schizoids, resistance to awarenessand contact were necessary for survival inchildhood, and they often still play a healthyfunction in adulthood. My advice is to treatresistance as just another legitimate feelingstate of the patient, something for you and thepatient to experience, understand, identifywith, and make clear. It should not be treatedas something to be gotten rid of.

It is necessary to bring together the parts ofthe self that the patient has kept isolated fromeach other. This can be done by bringing thesplit off parts into the room at the same timethe desire and the dread, the active and thepassive core selves, the attacker and the coreself. By bringing into awareness both parts ofa split self, the parts are clarified and a dialecti-cal synthesis or assimilation can begin. Certaintechniques, such as the gestalt therapy emptychair and two-chair techniques, may be help-ful, but the techniques are less important thanthe attitude of bringing the separated parts intosome kind of internal dialogue.



With regard to groups, schizoid patientsoften attend regularly and are important to thegroup process, although they may not be veryactive. They often come to group for a longtime and may feel ashamed about this. Whenschizoid patients do work in group and evenmanifest some change, they can become dis-couraged by their own shame over how long itis taking or over how the group process is notencouraging them. At such times they needsupport for understanding that it is legitimatefor the therapy to take that long. This is partic-ularly the case when other group memberscome and go more quickly. If growth is occur-ring, they need help to see themselves as otherthan defective for still being in group andencouragement to stay and continue their work.

The Course of TherapyThe schizoid compromise in therapy. The

schizoid patient is often emotionally neither innor out of therapy, just as he or she is neitherin nor out of other relationships. In therapy thisis accomplished by an infrequent but stableschedule, by being present without being in-timately connected or allowing strong affects,and/or by being in a group but not working.

Schizoid patients will often be "untouch-able" in the sense of putting up a mask or wallor showing other signs of lack of intimacy,defense, resistance, or retreat from contact.However, they are usually not otherwise con-trolling or manipulative.

These individuals usually focus on wantingsomething fixed or external regulation, on"How do I change this?" rules, fix-it ap-proaches, and shoulds (especially for otherpeople) rather than on affects, needs, or deeperunderstanding. Expressing emotion is difficult,delayed, or restrained, and they often react tonarcissistic injury with painful, prideful, with-drawal. Isolating is easier for schizoids thanfeeling despair or injury.

Underlying pattern. In the active core selfmode the patient longs for love, and the thera-pist becomes the avenue of hope. Since it isdifficult for schizoid patients to feel desire orneed fully, they often show pride in renouncingneed and shame or fear at becoming aware of

need. This can take the form of total denial,acknowledging but trivializing, or intellectual-izing the need without feeling it. These patientsproject hope onto the therapist but then fight it.They are usually unaware of this process andcontinue presenting problems to work on whilestubbornly fighting. Although the fighting isostensibly about what is being discussed, ac-tually it is about core shame and terror.

So, how does the therapist know how mean-ingful the therapy and the therapist are to thepatient? It usually shows subtly in behavior:For example, the patient keeps coming, and ifthe therapist does something that injures thetherapeutic relationship, the patient reacts, of-ten strongly. However, when the patient doesbecome aware of his or her attachment to andneed for the therapist, the immediate reactionis often anger: "1 don't want to need you, todepend on you. It makes me so angry!"

The schizoid patient fears loss throughabandonment. "If you really knew what I amlike . . ." is a frequent comment of schizoidpatients, even late in therapy. The inner schiz-oid world is characterized by a constant fear ofdesertion and feelings of being unwanted andunlovable, all of which may remain out ofawareness until they emerge well into the ther-apy. The fear of abandonment relates to thepatient's attitude toward his or her own intensehunger, and even if the hunger itself is not inawareness, it colors the schizoid patient's adultfunctioning.

The schizoid patient wants to ensure thetherapist's or lover's presence, to "possess"the other. This is most often represented infantasy (e.g., using sadomasochistic symbol-ism). One aspect of this is an antilibidinalattack on the needy self. There is also a dis-guised dependence andVor oneness (e.g., bond-age can symbolically ensure connection or one-ness with the significant other). Generally,schizoid patients are not demanding or control-ling of the therapist, except for the isolatingdefenses. However, it is usually a long timebefore the patient is aware of these underlyingprocesses.

No therapist can completely satisfy theschizoid patient's intense cravings. When the



therapist inevitably fails in his or her response,this supports the patient's projections that thetherapist is intrusive and/or abandoningor asuseless as the patient's parents were in meetingneeds. This is reinforced even more if thetherapist actually is controlling, intrusive, orabandoning, which makes the patient's percep-tion not entirely inaccurate. This is true regard-less of the therapist's rationale or good inten-tions. Even ordinary reflection or simple focus-ing experiments can be controlling or intrusivedepending on how they are done and how thetherapist relates to the patient.

Schizoid patients often oscillate betweenhungry eating and refusal to eat. This is trueboth literally and figuratively, although morethe latter. Mostly they isolate, occasionally ap-proaching out of need and then isolating again.This is not surprising in light of the basicpattern of approaching in need and withdraw-ing in fear and dread.

In the regressed, hidden, passive mode,schizoid patients regard others as too danger-ous, intrusive, devouring, subjugating, andsmothering. They want to escape from thisdanger as well as to find security, which leadsthem to long for the womb or temporary deathas a relief from an empty outer world and anattacking inner world. Relationships are toodangerous, so part of the self is kept untouch-able even when the patient recognizes cogni-tively what is happening.

Stages of TherapyOrdinary, utilitarian therapy. The beginning

schizoid patient is often in search of relief ofsymptoms and ways to deal with practical situ-ations. With therapeutic support and practicalmanagement of life situations comes relief andthe possibility of either stopping therapy hav-ing gained some respite or going deeper andworking with underlying issues.

The plateau created by the schizoid compro-mise. At this stage the schizoid patient usuallyhas a vague sense that something is missing,that something more in life is possible. Some-times this follows work at the previous stage;sometimes patients begin therapy at this stage.There is often resistance to or fear of going

deeper as well as fear of being more dependenton the therapist. The patient usually feelsshame at his or her weakness and need andfears collapse if the self becomes too weak.

Patients may stabilize at this stage and feelsomewhat better. It is a stage characterized bythe schizoid compromise, albeit with some be-ginning exploration into the twin fears of beingmore connected or more separate. However, atsome point the patient must decide whether tostay in therapy and go deeper or leave. Thisdepends in large part on how resistance fearsare dealt with, how the relationship develops,and the supports available to the patient.

Deeper work begins with the development ofthe therapeutic relationship and as the patientbecomes aware of and deals with feelingsabout the therapy itself. If the patient stayswith feelings and beliefs that arise, the fear andshame are usually too strong to support moreintimate work immediately. But from the halfsafety of the compromise position, the patientand therapist can develop the relationship aswell as greater awareness and centering skills.Gradually, the fear and shame will decreaseenough to go step-by-step beneath the plateau.

Going below the plateau. Some patients ob-tain enough relief by this point and decide toleave therapy rather than completing the deeperwork. They are left living a half-in and half-outlife, but perhaps with more comfort, connec-tion, and connection while separating. Patientscan survive here and perhaps even be thoughtof as leading lives of ordinary human unhappi-ness. Other patients at this stage will "take abreak" from therapy and plan to return.

Going deeper is difficult and time consum-ing. It means reaching the level at which theinner, regressed, core material is dealt with andreal character reorganization can occur. How-ever, even after the fear is relatively workedthrough, the remaining shame requires a tre-mendous amount of work while trust developsand the preverbal, infantile levels of the selfare worked through.

Interpersonal contact and intrapsychicwork. At each stage there is a correspondencebetween the interpersonal contact or relation-ship development between therapist and patient



and awareness work on the powerful innerneeds and terrors this contact arouses. The pa-tient usually fears that these needs and feelingsmight be so intense that they will destroy theself and the therapist. The patient is also oftenterrified that his or her ego will break down asthe self is experienced more fully. The experi-ence of no intimate human relatedness and theaccompanying experience of being utterlyalone is understandably terrifying. It is oftenexperienced as "black abyss." No one in theschizoid patient's past has understood the true,core self.

Thus it is not surprising to find tenacious re-sistance at this stage. After all, maintaining badinternal objects may well seem preferable tohave no internal objects at all. This is one rea-son that deep trust and foundation work mustbe done before deeper working through can beboth safe and effective.

Two related questions arise for the patient atthis point: Can the therapist be of more usethan the patient's parents were, and can the pa-tient stand being aware of his or her early, corematerial?

Additional GuidelinesRelationship. Build support for good bound-

aries and good contact. Provide a safe environ-ment. Watch for the twin dangers of intrusionand abandonment. Do not do what the patientexperiences as intrusivenot even in a goodcause. Needless to say, abandonment is not agood thing. Be contactful, emotionally directand open, and easygoing. Let the relationshipbuild with time, caring, and acceptance. Be in-viting but not intrusive. The goal is contact, notmoving the patient somewhere. Identify andvalidate the patient's experience using em-pathic reflections. Let it be OK that trust buildsgradually and that movement is slow.

Contact the hidden, isolated core self. Thepatient needs the therapist to contact the pa-tient's core self so that he or she can feel likea person. The schizoid patient cannot do thisfor himself or herself. The trick is to do itwithout being intrusive or confrontive. This isdone by good contact, experiments and reflec-tions, and a steady, inviting presence. Cathartic

release of emotions is not helpful with theschizoid patient unless expressed by the coreself.

Remember that resistance to awareness andcontact was necessary for survival and maystill be. Respect it and bring it into awarenessas something to be accepted. With this aware-ness comes a choice that the patient did nothave previously.

Work on integrating parts of the self: desireand dread, active and passive core selves,internal attacker and core self.

In group invite participation but allow theschizoid patient to play a passive role withoutbeing pejorative. Follow the patient's leadabout timing. If the patient wants to continueand feels ashamed of how long it is taking, of-fer support by acknowledging progress (truth-fully only), clarifying what is in process andwhat is next, and normalizing the lengthiness(truthfully only).

Audience Questions and My AnswersQuestion: What kind of contract do you

make for continuing therapy with schizoid pa-tients?

Answer: I don't make explicit contracts. Iwork in a here-and-now mode so I'm not surehow to answer that question. I try to be asstraightforward as I can about what can bedone in therapy and how long it takes. It's theonly way I know to work with what is emerg-ing rather than with something preset.

Question: Transactional analysts use con-tracts, particularly in groups. Everyone has acontract, and group members all know whatcontracts the other members have. When some-one new joins the group, that person strugglesto decide what his or her contract is. I've ex-perienced schizoid patients repeating the samecontract for years, and I'm wondering ifyou've dealt with that.

Answer: I guess it would be appropriate toask the person what he or she wants to focuson and to get out of the groupor out of in-dividual therapy. That may be the rough equiv-alent of a contract. But if everybody else ingroup has a contract, I'm not sure how I wouldhandle that. I would not want to single out a



schizoid patient as being too defective to havea contract.

Question: What are some of the less obviouscues for connection and disconnection?

Answer: Eye contact, change of facial color,muscle tightening. There's a subtle increase inthe quality of connecting in the eyes with aconnection. With disconnection, the energymoves away, the color in the face changes, andoften the breath is held. There are also cues inthe flow of speech, especially in fluency. Thestream of talk becomes blocked or disruptedwhen the patient disconnects.

Question: Please say something about thegestalt techniques that you use with schizoidpatients and how they differ from traditionalpsychoanalytic approaches.

Answer: First, I'd be careful about tech-niques, including gestalt techniques. I wouldlead with the paradoxical theory of change,although many gestalt therapists don't operatethat way. They pull up the empty chair or thepillows to pound without regard to what's hap-pening in the relationship. 1 do not advocatethat at all.

Gestalt experiments that are more interper-sonally contactful are more suitable for schiz-oid patients than the empty chair. This wouldinclude, for example, experiments that in-volved looking at you (or others in a group)and maintaining good breathing. Experimentsthat involve exploring distance can also be use-ful, for example, moving close and then away.One can either move around the room in doingthis or change the position of chairs: "How doyou feel if I move closer?" Then you observeto see what the patient does, for example, if heor she wants more distance: Does he or shepush me away? Signal me away? Take no ac-tion? Supporting the feeling and movementwith good breathing is crucial. When it be-comes spontaneously obvious that there is aninternal conflict one can experiment with aninternal dialogue between the parts using twochairs or other forms of role playing. I havealso done this kind of exploration using psy-chodrama techniques rather than the emptychair. I don't use a lot of techniques, but theycan be useful in this wayas long as they are

within an emphasis on the relationship, are notused to avoid patient-therapist contact, arearranged mutually by therapist and patient, anddo not become an end in themselves.

Question: More on contact and distancing:As you observe the cues you mentioned, howdo you avoid the paradox of pointing out con-tact and the patient feeling intruded on orpointing out distance and the patient feelingsome kind of abandonment?

Answer: Or feeling criticized merely becauseof the observation. 1 don't think you can avoidthat. I try to be careful with my own self-awareness and not deceive myself about whatI am actually feeling and doing. Am I reallytrying to connect with what is emerging, forexample, the distance issue, or am 1 feelingjudgmental or aiming at changing the patient?I try to notice what happens when I make anobservation. If the patient feels criticized andI can be open to thatand not have to defendmy honor as a therapist, so to speakthen Ican work with the patient feeling intruded onor feeling I'm watching them so closely thatthey're like a bug on a board. 1 pay particularattention to the context and to the subtext ofhow I made my observation. If I am tense, off-handed, sarcastic, flat, and so on it may berelevant to why the patient feels intruded on.You work with the patient's experience openly,without assuming you are not a part of theproblem. If you are open, the patient will pickup your openness in exploring the interactionbetween him or her and you. If the therapist isnot defensive and is open, the interaction canbe useful, and a breach in the relationship orsafety can often be repaired. And in the repair,there is often growth such that the relationshipand the patient are stronger.

Often what emerges is that the exposure thepatient feels on hearing the therapist's observa-tion triggers shame in him or her. This must beexplored and respected. The therapist musttake responsibility for being part of that pro-cess. However, you can't be too careful abouttrying to avoid such risks and still be an effec-tive therapist. We can only be sensitive, awareof the context, our patients, our mood, and howwe are present, and be willing to repair.



Question; I believe you said schizoid pa-tients often feel humanly connected while inisolation without being.. . .

Answer: Unfortunately they don't. Theywant and need to feel humanly connectedwhile they are separated. They will often sub-stitute being connected symbolicallyfor ex-ample, in dream imagery or fantasy.

Question: For 11 years I worked with a se-verely schizoid patient who was diagnosed asan extroverted schizoid. He had such a strongneed to be in contact and community that itappeared as an "as if self. But internally therewas this severe schizoid process going on, andI had to work hard to undo that extrovertedqualityin the Jungian sense that he came intothe world with that innate extroverted self.What do you think about such an individual?

Answer: I don't know about the innate selffrom the Jungian standpoint. One of the waysthat people with schizoid issues often presentto the world is with extroverted behavior, withschizoid processes underneath. Often I am sur-prised at how much shame and schizoid pro-cess can be found in people who appear to bevery extroverted. They will experience thisthemselves, with surprise, when they get to adeeper level of awareness. 1 see a lot of theschizoid process underlying apparently extro-verted, hysterical, dramatic behavior. That ispart of why some people think that the schizoidprocess underlies everything. Even extrovertswho make good social contact reveal schizoidissues when you get to an intimate level withthem or get beneath the words.

Richard Erskine (moderator): I appreciatethe broad theoretical overview you have of-fered us, Gary, and how much you have con-densed into this short presentation. To summa-rize a bit, I think perhaps one of the most im-portant things you have been sayingandsomething that needs to be emphasizedisthat the schizoid process is often not observ-able. Frequently, schizoid patients present ashighly functioning individuals, and it is onlythrough phenomenological experience that theyand we come to understand and appreciate theschizoid processes that underlie so much oftheir lives.

Gary Yontef, Ph.D., FAClinP. is a Fellow ofthe Academy of Clinical Psychology and aDiplomate in Clinical Psychology (ABPP).Along with Lynne Jacobs. Ph.D., he co foundedand codirects the Gestalt Therapy Institute ofthe Pacific, a contemporary gestalt therapytraining institute. He was formerly president ofthe Gestalt Therapy Institute of Los Angelesand for 18 years headed its training program.He is an editorial member of The GestaltJournal, editorial advisor of the British GestaltJournal, and chairman of the Executive Boardof the International Gestalt Therapy Associa-tion. His book, Awareness, Dialogue and Pro-cess: Essays on Gestalt Therapy, has beentranslated into four languages. He has alsowritten over 30 articles and chapters on ges-talt therapy theory and practice. He was for-merly on the UCLA Psychology Departmentfaculty and chairman of the ProfessionalConduct Committee of the Los Angeles CountyPsychological Association. Please send reprintrequests to Dr. Yontef at 1460 7th St., Suite301, Santa Monica, CA 90401-2632 or contacthim via email at [email protected].

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44185226 Psychotherapy of Schizoid Process

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