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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

Psychotherapy of Schizoid Process


Gary Yontef

Abstract In this article I use the term "schizoid" to re-


Schizoid process is one of the most ubiq- fer both to the true schizoid and to the patient
uitous personality patterns, but it is insuffi- who functions with significant schizoid pro-
ciently discussed in the literature. This ar- cesses or defenses but does not fit the full
ticle offers a description of both the true diagnostic picture.
schizoid and the more prevalent schizoid
process that runs through various types and Presenting Picture of the True Schizoid
levels of functioning. Schizoid process and The true schizoid usually presents as a loner,
personality type are described, including someone who is profoundly emotionally iso-
thecharacterological organization, interper- lated, who has few close friends, who is not
sonal processes, and developmental origins very close even in "intimate" relationships,
of schizoid process. Therapy of schizoid who drifts through life, and for whom life
process is discussed in terms of presentation seems boring or meaningless. Schizoid patients
of the schizoid in psychotherapy, develop- usually show extreme approach-avoidance dif-
ment of the therapeutic relationship, stages ficulties. They often come to therapy because
of therapy, and treatment suggestions and of loss or threat of loss of a relationship or be-
cautions. cause of relationship difficulties at work. They
frequently describe themselves as depressed
The schizoid process is important enough to and tend to identify more with the spaces be-
warrant more attention than it currently re- tween people than with interhuman connec-
ceives, partly because, to some degree, every- tions. In therapy, as in many of their relation-
one experiences some facets of it. Discussions ships, they tend to be present but not with
about the schizoid process can clarify issues vitality—that is, not "in their body" or with
related to contact, isolation, and intimacy in their feelings.
relation to people with a variety of character Schizoid patients tend to come to therapy
styles who operate at levels of personal func- regularly but do not appear to be engaged emo-
tioning ranging from normal neurosis through tionally. A common reaction of the therapist in
serious character disorders. response to a schizoid patient is to become
True schizoids are also fairly common. sleepy, even if he or she does not have this
These are individuals for whom the schizoid reaction with other patients. There is so little
process is central to their dynamics and who fit human connection during sessions that it is like
the DSM-IV (American Psychiatric Associa- not having enough oxygen in the room. The
tion, 1994) diagnostic criteria. They tend to be first time this happened to me was with a
quiet patients who do not cause much trouble patient I liked. I thought perhaps I was getting
or make many demands. If the therapist does sleepy because 1 saw her right after lunch, so 1
not know about the schizoid process and how changed her hour. But that was not the prob-
to work with it, such clients may well be in lem. In fact, 1 never get sleepy with patients
therapy for a long time without really dealing —except occasionally with a schizoid patient.
with their most basic issues.
This article is a modified version of a keynote address The Existential Terror Underneath
given on 20 August 1999 at the annual conference of the To people with schizoid character organiza-
International Transactional Analysis Association in San tion, real human connections are terrifying. In
Francisco. their fantasy life and their behavior, these
individuals try to live as if in a castle on an

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

island where they are totally safe. The main others. The separating process involves in-
feature of this isolation is a denial of attach- creasing distance, closing off the boundary, be-
ment and the need for other people. Of course, ing alone and not taking in, with the boundary
living that way brings on another terror—the becoming less porous and closed to exchange;
terror of not being humanly connected. If their at the extreme, the boundary becomes closed,
tendency to defend themselves by isolating like a wall. People need both connecting and
were to be fully realized, they would not be separating.
connected enough to maintain a healthy ego. All living creatures need to connect with
Schizoid individuals have to struggle to their environment to grow. Just as we can only
maintain their human existence as individual survive physically by taking in air and water
persons. The human sense of self and good ego from the environment, human psychological
functioning cannot develop and be sustained development and maintenance also requires
without interpersonal engagement, but schizoid connection with the environment, especially
isolating defenses attenuate the interpersonal with other people. People can only grow and
bond to the point of endangering ego develop- flourish by connecting to the interhuman en-
ment and maintenance. Often schizoid people vironment.
will create in their fantasy life the satisfaction At the extreme end of the connection pole is
or safety they lack in their experienced inter- merger, enmeshment, and a loss of separate ex-
personal world. They also have human connec- istence, will, need, and responsibility; such to-
tions in safe contexts (e.g., at a geographical tal connection means death by merger, a disap-
distance), and disguised longings are often pearance of autonomous existence. Physically
found at a symbolic level (e.g., in dreams and it means merger with the environment; psycho-
daydreams). One frequent symbolic wish is to logically is means a loss of individuation and
return to the womb, which is seen as a state of separate existence. Human existence requires
oneness and safety. But, if that were possible, some degree of experienced separation from
it would make sustained human identity impos- the environment.
sible since it would exclude interpersonal con- So we see that oneness can be healthy or un-
tact. healthy, just as separating can be. Intimacy is
Contact and Contact Boundaries a healthy form of oneness, whereas a spiritual
To understand the importance of the schiz- retreat is a healthy example of separation from
oid process in all human functioning, we need ordinary contact. Ideally, the movement be-
to consider the concepts of contact and contact tween contact and withdrawal is governed by
boundaries. Contact is the process of experien- emerging need. We become lonely, we need to
tial and behavioral connecting and separating connect; we move into intimacy, momentary
between a person and other aspects of his or confluence, or ongoing commitment. Then we
her life field. The contact boundary has the move away from connecting with the other to
dual functions of connecting and separating the be with self, to rest s.nd recover, to center, or to
person and his or her environment (including find serenity. Thus we connect to the point of
other people), just as a fence has the dual func- satisfaction of need, then change focus accord-
tion of connecting and separating two proper- ing to a new emerging need. We separate from
ties. These dual functions involve movement a particular contact when withdrawal or differ-
along a continuum between the two poles or ent contact is needed. However, in health, a
functions of connecting and separating. person withdraws from contact while sustain-
The connecting process involves a closing of ing a background sense of self connected with
the distance between people, a receptiveness or other people and the universe.
openness to the outside—and especially to This flexible movement between close con-
other people—with the boundary becoming po- nection and separation preserves the sense of
rous so that one takes in from and puts out to being humanly connected. It is unhealthy when
this flexibility is lost and either separation or

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

connection becomes static because movement Twin Existential Fears


in and out of contact according to need is di- The typical childhood of the schizoid patient
minished or restricted. At one unhealthy ex- is marked by the experience of too much or too
treme the individual separates and isolates to little human connection. Too little refers to a
the point of losing a sense of being humanly lack of warmth and connectedness and a sense
bonded. Isolating in this way and to this degree of emotional abandonment; too much refers to
is crucial to understanding the schizoid pro- intrusive parenting that emotionally overrides
cess. For schizoids, the process of separating the capability of the infant or young child and
with underlying connectedness and connecting causes him or her to isolate or dissociate to
while maintaining autonomy is foreign. Their survive. Sometimes the abandonment and in-
lives are marked by the profoundly frightening trusion alternate.
and disturbing fact of separating without main- Given what we know about the importance
taining a sense of emotional connectedness and of flexible movement between connecting and
without a developed ability to connect again. separating for the growth and well-being of the
They do not connect to others with much hope individual, it is easy to understand how the
of being met and lovingly received. Schizoids typical childhood experiences of the schizoid
do not believe they can be loved, and they fear leave him or her with deep-seated, often un-
that even if a relationship is established, the in- conscious feelings of merger-hunger, on the
timate connection means losing autonomy of one hand, and simultaneous fear of entrapment
self and other. Even feeling the need to con- and suffocation on the other. These lead to uni-
nect would, in either case, be painful and/or versal twin fears that are fundamental to the
frightening. schizoid process: the panic or terror of contact
It is dangerous to move into intimate connec- engulfment/entrapment and the panic or terror
tion if you cannot separate when needed. If of isolation. These are particularly intense and
you think you are going to be caught up, de- compelling for the schizoid, who experiences
voured, or captured in the connection, it is ter- them at the existential level of survival or
rifying to move into intimate contact. On the death.
other hand, if you do not feel connected with Because the schizoid splits connecting and
other people, especially if you do not believe disconnecting, thus losing easy movement be-
you can intimately connect again, the separa- tween them, he or she is faced with the threat
tion or isolation is both painful and terrifying. of becoming stuck at one pole or the other.
Without movement one is fixed, stuck, stag- Therefore, schizoids think of relationships
nant, and unable to grow. Being stuck in any mostly in terms of potential for entrapment,
position on the continuum of connection and suffocation, and bondage. They do not trust
separation—which is the case when the schiz- that they will not devour the significant other
oid process is operating—involves a degree of or be devoured. They do not believe that sepa-
dysfunction, with some needs not being met. ration will happen as needed, and thus they do
Being stuck in an isolated position, a con- not feel safe to be intimately connected. Of
nected position, or a middle position between course, the danger of entrapment comes in
intimacy and isolation are all problematic. large part from their own hunger for oneness
Being fixed in a middle position is common and fear of abandonment, and the connection
in the schizoid process: The person is neither between their own merger-hunger and the fear
truly alone nor truly with another. This immov- of entrapment is mostly not in their conscious
able position between connecting and separat- awareness.
ing is a compromise to avoid the terror of be- Many schizoid patients start treatment with
ing completely alone in the universe, on the the expectation that they will be devoured or
one hand, or of being threatened by engulf- abandoned in therapy. Although they may be
ment, enmeshment, attack, and rejection, on conscious of this fear early in the process, the
the other. extent of the dual fears and the connection to

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

their merger-hunger is usually not in awareness that he wants to talk to anyone, but he is not
until much later. Until then the denial of both alone either.
attachment and the need for intimacy predomi- Another example is a man from Los Angeles
nates. Their own merger-hunger is projected who has a relationship with a woman who lives
onto others as a way of avoiding the awareness in New York City. He can have a weekend
by attributing it to someone else. Sometimes connection without the risk of losing himself
these anticipations or perceptions are a projec- or being trapped in the relationship. When
tion, although they can also be accurate. Monday morning comes, he will be thousands
Total isolation or abandonment is like death, of miles away in Los Angeles again while she
especially for the young child. Part of the stays in New York.
schizoid process is terror—although not neces- Another type of schizoid compromise in-
sarily conscious—of a triple isolation: isolation volves the person repeatedly pulling out of re-
from others, isolation of the core self from the lationships before making a commitment. Such
attacking self, and isolation within the core individuals go through a series of relationships,
self. A significant part of the schizoid process always finding a reason why they cannot con-
is a splitting between attacking selves and core tinue. A similar pattern is having multiple lov-
selves. At a deeper level there is also a kind of ers at the same time; the person engages one
isolation between aspects of the core self. In part of the self with one partner and another
gestalt theory this is conceptualized as a part of the self with someone else. One typical
boundary between parts of the self that inter- configuration is having a sexual relationship
feres with the boundary between self and with a lover, but without companionship and
other. building a life together, while maintaining a
Experiencing the self in a vacuum means primary but nonsexual relationship with a
loss of the sense of self as a living person. The spouse. Sometimes individuals who show this
resulting loneliness is profound. It is real prog- pattern will say something like, "Gee, why
ress in therapy when the true schizoid patient can't 1 get this together?" or ask "Why can't I
is able to experience loneliness and the desire get a woman who has both?"
for connection. Such patterns illustrate a core pattern: the
schizoid is impelled into relationship by need
The Schizoid Compromise: The In-and-Out and driven out by fear. When faced with some-
Program one with whom they might be intimate, they
One solution to the problem of avoiding find it both exciting and frightening. They are
complete deadness of self from lack of human afraid that they will devour their lovers with
connection while also avoiding the threat to their need or that the lover will be devouring,
existence and continuity of self from intimate deserting, or intrusive. They might lose their
contact is what Guntrip (1969) called "the individuality by overdependence and merger-
schizoid compromise" (pp. 58-66). This refers hunger or lose the relationship by being too
to not being in but also not being out of en- much, too toxic, or too needy.
gagement with other persons or situations. An The solution to these dilemmas is Guntrip's
image that I think I borrowed from Guntrip schizoid compromise—to remain half in and
seems apt here: "How do porcupines make half out of the relationship, whether in the
love? Very carefully." There are several com- form of marriage without intimacy, serial mo-
mon "very careful" patterns of the schizoid nogamy, or two lovers at the same time. Needs
compromise. and fears will often be either denied or ac-
For example, a writer is too lonely to write knowledged in an intellectualized manner.
in his apartment, so he goes to a coffee shop Frequently such individuals will oscillate be-
with his laptop computer and manuscript. tween longing for the intimate other and reject-
There he is not really connected with anybody, ing him or her, or they may stay in a stable
especially since he does not give out signals halfway position not able to commit to being

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

fully in the relationship or discontinuing it. (including in therapy), those with whom they
They are tempted repeatedly to leave the rela- are relating have the sense of being shut out
tionship and live in a detached manner, but of- while the schizoid is shut in, cut off, and out of
ten they return again and again. touch.
When touched emotionally or feeling inti- What is not always obvious with these in-
mate, the schizoid may become annoyed, dividuals is that they still have a capacity for
scared, fault finding, and disinterested. Mean- warmth, in spite of the schizoid process. This
ingful contact with another leads to crisis, and may come out in various ways, for example,
crisis leads to abolishing the relationship. They with pets but not with people. 1 remember one
cannot live fully with the other, but they cannot schizoid woman who said that "the only people
live without the other either. Being with threat- 1 trust are dogs," which she did not mean as a
ens death-level confluence; being alone threat- joke. With such patients the therapist needs to
ens death-level isolation. So the schizoid lives be sensitive to subtle shifts in order to pick up
suspended between his or her internal world and gauge emotional reactions. This is espe-
and the external world without full connection cially true since schizoids often show a low
with either. Suspended in the death-level con- level of manifest interest and affective energy,
flict between total isolation and being swal- appearing to be absent minded and mentally
lowed up, these individuals often feel tired of half listening.
life and the urge for temporary death. This is Most often schizoids will express a desire to
not active suicide, just exhaustion from living be free of any impingement or requirement to
a life with insufficient nourishment. do anything. In a relationship they will often
talk about how they want to be able to go out
Themes in Therapy and not have to face any limitations. At these
The discussion so far points out the major times the desire to connect is usually out of
themes that emerge in therapy with schizoid awareness.
individuals: isolating tendencies, denial of at- However, the schizoid process involves
tachment, themes of alienation, and feelings of more than the simple isolating behavior of a
futility. shy or anxious person, more than social anxi-
Isolating tendencies. Since being close ety, obsessive compulsive behavior, or intellec-
causes schizoids to feel claustrophobic, smoth- tualizing, although a schizoid character pattern
ered, possessed, and stifled, they often turn may underlie any of these other isolating pat-
inward and away from others. Thus commit- terns. The issues of the schizoid involve life-
ment to relationship is very hard. They treat threatening levels of existential vulnerability.
their internal world as real and the external Because this profound vulnerability makes the
world as not real. They often have a rich fan- relationship with the therapist deeply terrify-
tasy life and tepid affective contact with others. ing, it takes a long time for the therapeutic rela-
In isolation they often fantasize about merger tionship, including trust, to develop.
or confluence as something to be longed for or It should be noted that the cognitive descrip-
to feel panicked about—or both. In actual or tions in this article provide a kind of a map for
fantasy contact they fantasize about isolation the therapist, but one that only points the way
either as a positive way of getting their own to work at a feeling level. Awareness and
space or as something terrifying—or both. working through with these individuals re-
Schizoids manipulate themselves more than quires developing a trusting relationship; no
they interact with the environment. fundamental change can happen with the schiz-
Such individuals usually appear detached, oid on a purely cognitive basis.
solitary, distant, undemonstrative, and cold Denial of attachment. For children who later
("cold fish"). They do not seem to enjoy much become schizoid adults, one way of coping
and have few if any friends. They appear to with a world that is too big, menacing, intru-
live inside a shell, and in most relationships sive, unresponsive, and/or abandoning is to

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

deny any need, weakness, and dependency and intense shame. In fact, shame is a fundamental
to promote the illusion of self-sufficiency. process for schizoids. They are easily shamed,
They learn to survive by living without feeling although that is not always obvious because
dependence, desire, need, or fear. The schizoid they deny that they are attached or that they
is especially trying to avoid burdening and kill- need anything. When they feel safe enough to
ing parents with his or her needs. start exploring their shame, they manifest a
Schizoids avoid awareness of attachment in great deal of loathing for their needy self.
various ways. The most common is splitting However, if the therapy is confrontive (e.g., in
off or disassociating from needs and feelings the way encounter groups and some confron-
that are overwhelming. Conformity can also be tive gestalt therapists used to be), demands
a means of avoiding awareness of need and quick change, or is insensitive to issues of
fear as can obsessive-compulsive self-mastery, shame, these feelings will not emerge because
addiction to duty, or service to others. One can the patient will not experience the necessary
avoid attachment needs by being regulated by fundamental trust in the therapeutic relation-
rules and regulations rather than by vitality ship.
affect, or by conforming and serving, thus Themes of alienation. Schizoids feel so alie-
forming a false self that consists of a conven- nated and different from others that they can
tional, practical pseudo-adult who masks a experience themselves literally as alien—as not
frightened inner child. belonging in the human world. I have a patient
Denial of attachment results in shallow re- from Argentina who quoted a saying in Span-
lations with the world. Compulsive activity, ish that describes her experience: She feels like
compulsive talking, and compulsive service to a "frog who's from another pond."
causes can all mask a shallowness of affective In their alienation, these individuals cannot
connection. Some people who appear to be imagine themselves in an intimate relationship.
extroverted are actually schizoid in their under- The people world seems strange and frighten-
lying character structure. ing, even if also desirable. When they see cou-
In the extreme, the schizoid's denial of at- ples being intimate, they are often mystified:
tachment results in his or her being mechani- "How do they do that?" No matter how they
cal, cold, and flat to the point ofdepersonaliza- force themselves to date or to meet new peo-
tion; the individual loses a sense of his or her ple, they cannot imagine themselves in a sus-
own reality and experiences life as unreal and tained intimate relationship. This leads to the
dream like. Of course, not all schizoids deper- fourth theme.
sonalize to this extent. Feelings of/utility. The schizoid experiences
Schizoids often may deflect the importance loneliness, futility, despair, and depression, al-
or impact of praise and criticism as protection though the latter is somewhat different from
against attack, disapproval, disappointment, neurotic, guilt-based depression. Both are com-
and so on. Although they strive to feel and prised ofdysphoric affects and an avoidance of
appear unaffected by praise and criticism, they primary emotions and full awareness. How-
are actually sensitive, quick to feel unwanted, ever, neurotic depression has been described as
and suffer from a deep underlying shame (Lee "love made angry." That is, the depressed per-
& Wheeler, 1996; Yontef, 1993). Their self- son feels angry at a loss followed by sadness
representation is always a shameful sense of and broods darkly against the "hateful denier."
self as being defective, toxic, and undesirable. This aggressive emotional energy then gets
They live internally as if they were always turned against the self.
deserted because of their own defect. They are In contrast, schizoid despair has been de-
especially contemptuous of their own "weak scribed as "love made hungry." The person
(needy) self." experiences a painful craving along with fear
When the need they have been denying starts that his or her own love is so destructive that
to emerge into awareness, schizoids experience his or her need will devour the other. The

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

schizoid feels tantalized by the desire, made even when physically separated. This support
hungry, and driven to withdraw from the "de- for connection and separation is needed
sirable deserter." The deep, intense craving is throughout infancy and toddlerhood.
no less painful because it is consciously re- Ideally, the infant/child leams that he or she
nounced or denied. can be alone in the presence of the mother and
In ordinary depression the person has a thus in intimate relations with others. In this
sense of the self as being bad; usually he or she way children learn that they can have privacy
feels guilty, horrible, and paralyzed. The schiz- and self-possession without loss of the other,
oid, on the other hand, feels weak, depersonal- that they can be physically separate or have
ized, like a nonentity or a nobody without a their own feelings and thoughts in the presence
clear sense of self. Guntrip said that people of the parent and still feel connected and feel
much prefer to see themselves as bad rather connected-with when they have needs and feel-
than weak. They will typically refer to them- ings. The child can be alone in outer reality be-
selves as depressed more readily than weak, cause he or she is not alone in inner reality.
bad rather than devitalized, futile, and weak. The development of these capacities depends
Guntrip (1969) called the depressive diagno- on early parental experience, the development
sis "man's greatest and most consistent self- of object constancy, and so forth.
deception" (p. 134). He went on to say that
psychiatry has been slow to recognize "ego Schizoid Development
weakness," schizoid process, and shame. "It Unfortunately, the course just described is
may be that we ourselves would rather not be quite unlike the early experience of the schiz-
forced to see it too clearly lest we should find oid, whose childhood tends to be marked al-
a textbook in our own hearts" (p. 178). Fortu- ternately by experiences of intrusion and being
nately, I think in the last few years there has overwhelmed, on the one hand, and feeling
been a real opening in therapeutic circles to empty and alone in the universe, on the other.
recognizing relationship and shame issues The schizoid then uses worry, fantasy, and iso-
present in the therapist as well as in the patient lation to protect against these experiences.
(Hycner & Jacobs, 1995; Yontef, 1993). Although nature and mother arouse powerful
emotional needs in the child, if there are either
Healthy Development insufficient warm, loving responses or an ex-
The self can only experience itself in the act cess of intrusive, overwhelming responses, the
of experiencing something else—and being need only increases, and the child experiences
experienced. Cohesive, healthy self-formation painful deprivation or unsafe feelings as well
depends on contact with the mothering person as anxiety at separation and/or connection. A
that is neither too little nor too much. deep intimacy-hunger grows in the child.
From birth, infants are equipped to be both The schizoid's early experience is that moth-
separate from and connected with others. er is not reliable, usually because she is alter-
Stem's (1985) research confirmed that from natively intrusive and abandoning. Mother not
the beginning infants know themselves and only cannot tolerate, contain, and guide the
connect with the human environment. For their child's affects (e.g., need, anger, exuberance,
maturational potential to develop, infants must even love), she finds them threatening and
be welcomed into the world and supported in overwhelming and treats them as toxic. These
being themselves and being connected. This mothers usually become overwhelmed because
support starts with the mother restoring the of their own depression, life situation, or char-
connection severed by birth. The infant needs acterological issues; often they do not have the
to be made to feel that he or she belongs in the support they need to meet the child in intensive
world of people. Through a dependable mother affective states and to stay with him or her
and infant relationship, the infant leams that he until the affect has run its course. Clearly, the
or she is not emotionally alone in the world problem is with the mother, not with the child.

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

However, the infant or child's experience is devoured. When strong desire or need is
that his or her life forces and vitality appear to aroused, they tend to break off the relationship.
kill mother—or at least the connection to and Hatred is often used to defend against love
relationship with mother. If a young child has with its dangers and disappointments, a pattern
a tantrum and mother withdraws to her room that starts in early childhood.
for three days, the child's reality is that he or However, what happens to the lively emo-
she has emotionally killed mother. And, of tional energy that is held in? And how does the
course, killing mother would make the infant's schizoid stay sufficiently related to people to
life impossible as he or she cannot live without support the survival of the self? One key pro-
a parent. cess is the development of internal rather than
The legacy for the child is that his or her life interpersonal dialogues. Instead of someone
force threatens mother, which is equivalent to with a relatively cohesive sense of self interact-
the child experiencing that "my life threatens ing with others, there is a sense of self in
my life." Anything from within, even some- which aspects of personality functioning are
thing good, turns bad and destructive with ex- split off from each other. The most commonly
posure. The only hope is to keep everything encountered manifestation of this in psycho-
inside and thus invisible. The child must, at all therapy is the split between an attacking self
costs, avoid causing total emotional abandon- and the "core" or "organismic" self. When the
ment by or intrusion and annihilating counter- organismic self shows characteristics of being
attack from mother. Therefore, the child suf- in need or emotional, the attacking self makes
fers isolating himself or herself to avoid an self-loathing, judgmental statements about be-
even more devastating deprivation—the loss of ing "weak" or "needy." One might characterize
the mother and the child's relationship with this as attacking and shaming the organismic
her. Unfortunately, this leaves the child with a self, which it calls the "weak self." The person
huge hunger that cannot be satisfied, a hunger often identifies with the attacking self and
that is projected onto the mother, who is then thinks of his or her own love as so needy that
seen as devouring. And a mother who actually it is devouring and humiliating.
does devour makes this even more real and To the degree that the person's contact is be-
frightening. tween parts of the self rather than a relatively
unified self in contact with the rest of the
Splitting the Self person/environment field, the person is left
An important part of how the child copes with a deep and painful intimacy-hunger (often
with this situation is by splitting the self. denied), dread, and isolation. The internal at-
Survival is achieved by relating to the world tack is usually not only on the self that is
with a partial self or "false self," one that is de- needy, hungry, and weak, but also on the self
void of most significant affect and relates on of passion and bonding—even happy passions.
the basis of conforming to others' requirements Within the core self there is another split,
rather than on the basis oforganismic experi- which I will only consider briefly. This split is
ence. Guntrip (1969) used the phrase "the liv- between the self (or the self-energy) that con-
ing heart fled" (p. 90) to describe the situation nects and fights with the attacking self and the
in which the vital energies, emotions, and vi- core energy that has an urge to isolate even
tality affects are held inside, leaving an empty more, to go back to the womb. The retreat from
shell to interact with others and to direct hu- the internal self-attack is designed to protect
man relations. the core life energy, which is kept isolated in
This schizoid pattern creates external rela- the background to protect it. It is a fight for
tions that are not marked by warm, live, puls- life.
ing feelings. Instead, when interpersonal nur- There are a couple of other things that occur
turance is available, schizoid individuals fear a because of this process that I have not yet
loss of self from being smothered, trapped, or mentioned. One is that, as part of schizoid

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dynamics, cognitive processes are often used in The unfinished business of schizoids, their
the service of feeling humanly connected while most central life script issue, centers on the
remaining isolated rather than in preparation struggle to make "bad introjects" into "good
for interpersonal contact. introjects." However, this usually does not suc-
Self-attack is an internal dualism that divides ceed easily. The bad introject usually stays
the person into at least two subselves. When rejecting, indifferent, and hostile until very late
the self-attack is on the feeling self, it results in in therapy. While the therapist may think that
shame, humiliation, and psychological starva- progress is being made as some of these issues
tion. It creates the defect of a divided rather are uncovered, the schizoid patient often expe-
than unified self and makes the life energy riences only intensified self-loathing. Frustra-
(i.e., feelings) a sign of being defective. It cre- tion and failure trigger the unfinished business
ates a sense that since I feel, want, and need, and the rest of this negative script, including
therefore I am unworthy of love and respect. isolating defenses, retroflected anger and rage,
So it is not surprising that schizoids often strong defense of the negative sense of self,
attempt to annihilate or master their feelings of harsh self-attacks, and shame. It takes a great
need, sometimes in a sadomasochistic way. For deal of patience and a long time to work
them, self-attack is not directed toward their through these issues.
"doing"; it is an attack or attempted annihila-
tion of the "being." Working with Schizoids and the Schizoid
However, being and being-in-relation are in- Processes in Psychotherapy
separable. The sense of self only develops in The Paradoxical Theory of Change. The
relationship, not in a vacuum. Feeling with and gestalt concept of the paradoxical theory of
feeling for other persons—and being felt for change (Beisser, 1970) says that the more you
by them—is vital for a healthy sense of self. try to be who you are not, the more you stay
Shared emotional experience is a part of learn- the same. That is, true change involves know-
ing to identify and identify with the self and to ing, identifying with, and accepting yourself as
identify with bonding with others. Because of you are. Then one can experiment and try
their isolating and denial of attachment, schiz- something new with an attitude of self-accep-
oids often operate without a sense of being tance. This contrasts with attempts to change
—the empty shell experience. This "doing" that are based on self-rejection or trying to
without a sense of "being" leads to a sense that make yourself into someone you are not.
being or life is meaningless. Schizoids usually Working in the mode of the paradoxical the-
feel this way, although they often attribute it to ory of changes promotes self-support, self-
a particular activity being meaningless rather recognition, and self-acceptance as well as
than to their own process. growth from the present state by experimenting
Even the core self—in reaction to the top- with new behavior This experimentation can
dog, critical self—is split. There is an engaged, be either the spontaneous result of self-
contact-hungry core self that does battle with recognition and self-acceptance or on the basis
the top-dog self, which can manifest in sado- of systematic experimentation. The therapist's
masochistic and bondage and discipline fanta- task is to engage with the patient in a way that
sies. In contrast, the passive, isolating core self is consistent with this paradoxical theory of
is regressive and imagines going back to the change. With schizoids, this means engaging
womb. It is this self that is in danger of losing with the patient at each moment and over time
human connectedness; it fears existential star- without being intrusive or abandoning, without
vation, loss of ego or sense of self, depersonal- sending the message that the patient must be
ization, being alone in a vast, empty universe, different based on demands or needs of the
even death. These fears can become known therapist or the therapist's system. While many
during quiet times, which may make calm, therapists might endorse this in the abstract,
peace, quiet, sleep, or meditation frightening. often their nonverbal communication creates

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pressure for the patient to change based on will patient's feelings as well as by acknowledging
power, conformity, or as a direct result of the his or her own flaws, foibles, and mistakes.
therapist's interventions. The dialogic therapist must trust in and sur-
The Dialogic Therapeutic Relationship. render to what emerges from the interaction
Some of the principles guiding work from this with the patient rather than aiming at a preset
perspective are the characteristics of dialogue goal. This approach recognizes, centers on,
according to Buber's (I965a, 1965b, 1967; tolerates, and stays with what is happening as
Hycner & Jacobs, 1995) existential theory. the therapist practices inclusion and thus fo-
They include: inclusion, confirmation, pres- cuses on present experience and moment-to-
ence, and surrendering to what emerges in the moment, person-to-person contact. In a sense,
interaction. progress is a by-product of a certain kind of
Buber's (1965b, p. 81; 1967, p. 173) term relating and mindfulness rather than something
"inclusion" is similar to the more common that is sought directly. The therapist relin-
term "empathic engagement." Inclusion in- quishes control and allows himself or herself to
volves experiencing as fully as possible the be changed by the dialogue just as the patient
world as experienced by another—almost as if does. As a result, truth and growth emerge for
you could feel it within yourself, within your both.
own body. Buber (1965b) called this "imagin- Subtext. Attitudes are often communicated
ing the real" (p. 81), that is, confirming the not by the text of what the therapist says, but
other's reality as valid. Both inclusion and em- by the subtext or how things are said. Nonver-
pathy involve approximation; however, inclu- bal cues have an especially powerful influence
sion calls for the therapist's more complete on schizoid patients, even if neither they nor
imagining of the other's experience than does the therapist are consciously aware of them.
empathy. Inclusion is more than a cognitive, For example, a gesture, tone, or glance will of-
intellectual, or analytic exercise; it is an emo- ten trigger a shame reaction in a patient with-
tional, cognitive, and spiritual experience. It out the therapist intending to do so and without
involves coming to a boundary with the patient either the therapist or the patient being aware
and joining with the patient's experience, but of the process (Yontef, 1993). And even when
it also requires the therapist to remain aware of this operation (i.e., the effect of the subtext) is
his or her separate identity and experience. in awareness, it may not be expressed or com-
This allows for deep empathy without conflu- mented on.
ence or fusion. Although they may appear to be distant and
Inclusion, or imagining the patient's reality, only vaguely present, schizoid patients (and
provides confirmation of the patient and his or many other patients as well) are exquisitely
her experienced existence. It involves accept- sensitive to nuances of abandonment, intru-
ing the patient and confirming his or her poten- sion, pressure, judgment, rejection, or pushing
tial for growth. Such confirmation does not —in fact, to any message or subtext that says
occur in the same way when the therapist they are not OK as they are. Such messages are
needs the patient to change and thus aims at a not only contrary to the paradoxical theory of
conclusion rather than meeting the patient with change, but they also trigger unfinished busi-
inclusion. ness from painful childhood experiences of
A dialogic approach requires genuine, unre- rejection and/or intrusion.
served communication in which the therapist is Sometimes I have tried to encourage a pa-
present as a person—that is, authentic, congru- tient to feel better, to convince the self-loathing
ent, and transparent—rather than as an icon of patient that he or she is not loathsome. By do-
seamless good functioning. The therapist can- ing so, I inadvertently sent the message that the
not practice this kind of therapy and also be patient's feelings and sense of self were so
cloaked in a psychological white coat. He or painful that 1 as a therapist could not tolerate
she must be present by connecting with the them. This was a repeat of the message the

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patient received from infancy: You are too and the therapist works to get the patient not to
needy, too much of a bother. When you as the feel despair, whose need is being served—the
therapist have a view of the patient that is more patient's or the therapist's? Can the therapist
positive than he or she has, the thing that you stand to stay in emotional contact as the patient
hear the most from the patient is, "You don't experiences despair, depression, hopelessness,
understand." 1 still hear that occasionally, and shame, and self-loathing? If the therapist can-
I have been working with these dynamics for a not or will not stay with the patient's experi-
long time. In such cases, good intentions create ence, he or she gives the patient the message
disruptions in the contact between therapist once more that the patient's experience is too
and patient and an impediment to working much to bear. This is like demanding a false
through. (For a poignant example of this pro- self, and it triggers shame and reinforces the
cess, see Hycner & Jacobs, 1995, p. 70.) childhood script.
I find it agonizing when patients I like hate The most important thing the therapist can
themselves and describes themselves as loath- do with schizoid patients is to work patiently
some, something totally contrary to how I and and consistently to inquire about and focus on
others (e.g., group members) experience them. the patient's experience, on what it is like to
For example, I have a bright schizoid patient live life with the subjective reality of being stu-
who makes excellent comments in the group, pid and loathsome. This approach is most use-
comments that other patients appreciate and ful when combined with careful attention to
from which they benefit. But his self-descrip- subtle signs of disruptions in the contact be-
tion is, "I'm stupid," which for him is an un- tween therapist and patient. Although schizoid
touchable reality. Attempts to induce him to patients will not tell you about them, you can
take in the views of others and thus modify his see subtle signs of connection and disconnec-
view of himself have proved predictably futile. tion if you are observant. Often the latter in-
When people say they like him, think he is dicate that subtext (nonverbal signs from the
smart, or appreciate his remarks, his response therapist) have triggered a shame reaction. This
is usually, "You don't understand." I eventu- is rich material if the therapist is willing to take
ally said, in effect, "You're right, I don't un- the initiative to explore it.
derstand, your reality is that you are stupid." The same holds true when the patient has a
As 1 stopped fighting with him about his nega- different view of you, the therapist, than you
tive sense of self, deeper work started. Instead have of yourself. If you honor the patient's
of pretense, I began to see more continuity of experience as one valid reality, not the reality,
thematic work. you can explore the discrepancy between your
In general, when the patient tells me that I do "reality" and the patient's "reality" and thus be
not understand, he or she is right. As the thera- consistent with the principles of dialogue, phe-
pist you do not have to agree with the patient's nomenology, and the paradoxical theory of
viewpoint, but it is important to realize the pa- change. Working with this attitude offers
tient's reality is as valid as the therapist's. growth for both patient and therapist.
Moreover, you cannot talk the patient out of Techniques: Schizoid patients are amenable
his or her reality even if you believe it is ac- to creative approaches that center on their
ceptable to do so. Rather, the task is to connect experience, on contact, and on what emerges
with and tolerate the patient's experience so in the therapeutic relationship rather than on
that he or she can leam to tolerate it—and then programs that try to get the patient some-
to grow beyond it according to the paradoxical where. This can be maximized by identifying
theory of change. schizoid themes as they emerge rather than
The "friendly" message of persuasion is ac- trying to formulate them according to a preset
tually an attempt to get the patient to change plan. If you show interest and inquire about the
his or her perception, belief, experience—that themes as they emerge, you do not need elabo-
is, to be different. If the patient is in despair, rate formulations to explain to the patient

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about his or her process or life script. Insight themes before they emerge in the therapy or a
will emerge from the interaction when the therapy in which the therapist does not under-
therapist follows these basic principles. Al- stand the schizoid process. A man who says he
though this may seem to take a long time, in wants intimacy but is always unavailable, cri-
the end it is more effective, safer, and no tical, busy, or too impatient is in the same pre-
lengthier than approaches that appear to obtain dicament. Treatment must proceed step by step
a quicker cognitive understanding. by exploring issues as they emerge with a
Working through—that is, destructuring and therapist who is informed by an understanding
integrating core processes—requires identify- of the schizoid process.
ing and staying with feelings as the patient For example, a man in a relationship keeps
explores his or her experience. It involves asserting that he wants his freedom. Inquiry
feeling the affect and is, of necessity, more and mental experiments start to clarify the sit-
than cognitive and/or verbal. The therapist uation. He is asked to describe in detail what
must be able to experience with the patient the happens when he is at home and to imagine
feeling of the empty shell, the core self, and what he would do if he were free. What emer-
the critic and to work with these feelings as ges is a relationship pattern in which there is
they emerge and naturally evolve. It means no movement into intimate contact and no
feeling the inner child's painful hunger, terror, movement to separate while maintaining the
and need for the defense and how, when, and sense of emotional bonding. This eventually
why it worked. It means feeling the experience links to early childhood experiences of being
of being an alien. Such working through re- emotionally isolated within a troubled family,
quires more intensive work over time than ther- with freedom only coming by being away from
apy that is only palliative. Any cognitive iden- the warring family situation. These isolating
tification of a theme before the patient can feel defenses were necessary in childhood, but sub-
it is, at best, preparatory for deeper work, work sequent exploration led the patient to discover
based on the patients felt sense of self and other solutions for himself as an adult.
others. An interpretation is only valid when it For most schizoids, resistance to awareness
is confirmed by the patient's felt sense of it. A and contact were necessary for survival in
cognitive identification before the patient can childhood, and they often still play a healthy
feel it lacks the patient's felt sense as a means function in adulthood. My advice is to treat
of confirming or disconfirming the therapist's resistance as just another legitimate feeling
interpretations. The cognitive focus is often a state of the patient, something for you and the
barrier to deeper work based on a felt sense. patient to experience, understand, identify
The schizoid needs the therapist to be able to with, and make clear. It should not be treated
contact the hidden core self without being in- as something to be gotten rid of.
trusive. This requires much sensitivity and It is necessary to bring together the parts of
awareness of the process so that openings can the self that the patient has kept isolated from
be found where the therapist and patient can each other. This can be done by bringing the
discover a way to symbolize the very young, split off parts into the room at the same time
primitive, preverbal sentiment of the inner core —the desire and the dread, the active and the
self. It also requires that the therapist be will- passive core selves, the attacker and the core
ing and able to admit errors and counter-trans- self. By bringing into awareness both parts of
ference so that breaches in the therapist-patient a split self, the parts are clarified and a dialecti-
relationship can be healed. cal synthesis or assimilation can begin. Certain
A woman who wants to marry and raise a techniques, such as the gestalt therapy empty
family but who relates to men using the schiz- chair and two-chair techniques, may be help-
oid compromise is not likely to benefit from ful, but the techniques are less important than
either an emphasis on contact skills and rela- the attitude of bringing the separated parts into
tionship discussions that prematurely consider some kind of internal dialogue.

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With regard to groups, schizoid patients need. This can take the form of total denial,
often attend regularly and are important to the acknowledging but trivializing, or intellectual-
group process, although they may not be very izing the need without feeling it. These patients
active. They often come to group for a long project hope onto the therapist but then fight it.
time and may feel ashamed about this. When They are usually unaware of this process and
schizoid patients do work in group and even continue presenting problems to work on while
manifest some change, they can become dis- stubbornly fighting. Although the fighting is
couraged by their own shame over how long it ostensibly about what is being discussed, ac-
is taking or over how the group process is not tually it is about core shame and terror.
encouraging them. At such times they need So, how does the therapist know how mean-
support for understanding that it is legitimate ingful the therapy and the therapist are to the
for the therapy to take that long. This is partic- patient? It usually shows subtly in behavior:
ularly the case when other group members For example, the patient keeps coming, and if
come and go more quickly. If growth is occur- the therapist does something that injures the
ring, they need help to see themselves as other therapeutic relationship, the patient reacts, of-
than defective for still being in group and ten strongly. However, when the patient does
encouragement to stay and continue their work. become aware of his or her attachment to and
need for the therapist, the immediate reaction
The Course of Therapy is often anger: "1 don't want to need you, to
The schizoid compromise in therapy. The depend on you. It makes me so angry!"
schizoid patient is often emotionally neither in The schizoid patient fears loss through
nor out of therapy, just as he or she is neither abandonment. "If you really knew what I am
in nor out of other relationships. In therapy this like . . ." is a frequent comment of schizoid
is accomplished by an infrequent but stable patients, even late in therapy. The inner schiz-
schedule, by being present without being in- oid world is characterized by a constant fear of
timately connected or allowing strong affects, desertion and feelings of being unwanted and
and/or by being in a group but not working. unlovable, all of which may remain out of
Schizoid patients will often be "untouch- awareness until they emerge well into the ther-
able" in the sense of putting up a mask or wall apy. The fear of abandonment relates to the
or showing other signs of lack of intimacy, patient's attitude toward his or her own intense
defense, resistance, or retreat from contact. hunger, and even if the hunger itself is not in
However, they are usually not otherwise con- awareness, it colors the schizoid patient's adult
trolling or manipulative. functioning.
These individuals usually focus on wanting The schizoid patient wants to ensure the
something fixed or external regulation, on therapist's or lover's presence, to "possess"
"How do I change this?" rules, fix-it ap- the other. This is most often represented in
proaches, and shoulds (especially for other fantasy (e.g., using sadomasochistic symbol-
people) rather than on affects, needs, or deeper ism). One aspect of this is an antilibidinal
understanding. Expressing emotion is difficult, attack on the needy self. There is also a dis-
delayed, or restrained, and they often react to guised dependence andVor oneness (e.g., bond-
narcissistic injury with painful, prideful, with- age can symbolically ensure connection or one-
drawal. Isolating is easier for schizoids than ness with the significant other). Generally,
feeling despair or injury. schizoid patients are not demanding or control-
Underlying pattern. In the active core self ling of the therapist, except for the isolating
mode the patient longs for love, and the thera- defenses. However, it is usually a long time
pist becomes the avenue of hope. Since it is before the patient is aware of these underlying
difficult for schizoid patients to feel desire or processes.
need fully, they often show pride in renouncing No therapist can completely satisfy the
need and shame or fear at becoming aware of schizoid patient's intense cravings. When the

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

therapist inevitably fails in his or her response, deeper as well as fear of being more dependent
this supports the patient's projections that the on the therapist. The patient usually feels
therapist is intrusive and/or abandoning—or as shame at his or her weakness and need and
useless as the patient's parents were in meeting fears collapse if the self becomes too weak.
needs. This is reinforced even more if the Patients may stabilize at this stage and feel
therapist actually is controlling, intrusive, or somewhat better. It is a stage characterized by
abandoning, which makes the patient's percep- the schizoid compromise, albeit with some be-
tion not entirely inaccurate. This is true regard- ginning exploration into the twin fears of being
less of the therapist's rationale or good inten- more connected or more separate. However, at
tions. Even ordinary reflection or simple focus- some point the patient must decide whether to
ing experiments can be controlling or intrusive stay in therapy and go deeper or leave. This
depending on how they are done and how the depends in large part on how resistance fears
therapist relates to the patient. are dealt with, how the relationship develops,
Schizoid patients often oscillate between and the supports available to the patient.
hungry eating and refusal to eat. This is true Deeper work begins with the development of
both literally and figuratively, although more the therapeutic relationship and as the patient
the latter. Mostly they isolate, occasionally ap- becomes aware of and deals with feelings
proaching out of need and then isolating again. about the therapy itself. If the patient stays
This is not surprising in light of the basic with feelings and beliefs that arise, the fear and
pattern of approaching in need and withdraw- shame are usually too strong to support more
ing in fear and dread. intimate work immediately. But from the half
In the regressed, hidden, passive mode, safety of the compromise position, the patient
schizoid patients regard others as too danger- and therapist can develop the relationship as
ous, intrusive, devouring, subjugating, and well as greater awareness and centering skills.
smothering. They want to escape from this Gradually, the fear and shame will decrease
danger as well as to find security, which leads enough to go step-by-step beneath the plateau.
them to long for the womb or temporary death Going below the plateau. Some patients ob-
as a relief from an empty outer world and an tain enough relief by this point and decide to
attacking inner world. Relationships are too leave therapy rather than completing the deeper
dangerous, so part of the self is kept untouch- work. They are left living a half-in and half-out
able even when the patient recognizes cogni- life, but perhaps with more comfort, connec-
tively what is happening. tion, and connection while separating. Patients
can survive here and perhaps even be thought
Stages of Therapy of as leading lives of ordinary human unhappi-
Ordinary, utilitarian therapy. The beginning ness. Other patients at this stage will "take a
schizoid patient is often in search of relief of break" from therapy and plan to return.
symptoms and ways to deal with practical situ- Going deeper is difficult and time consum-
ations. With therapeutic support and practical ing. It means reaching the level at which the
management of life situations comes relief and inner, regressed, core material is dealt with and
the possibility of either stopping therapy hav- real character reorganization can occur. How-
ing gained some respite or going deeper and ever, even after the fear is relatively worked
working with underlying issues. through, the remaining shame requires a tre-
The plateau created by the schizoid compro- mendous amount of work while trust develops
mise. At this stage the schizoid patient usually and the preverbal, infantile levels of the self
has a vague sense that something is missing, are worked through.
that something more in life is possible. Some- Interpersonal contact and intrapsychic
times this follows work at the previous stage; work. At each stage there is a correspondence
sometimes patients begin therapy at this stage. between the interpersonal contact or relation-
There is often resistance to or fear of going ship development between therapist and patient

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

and awareness work on the powerful inner release of emotions is not helpful with the
needs and terrors this contact arouses. The pa- schizoid patient unless expressed by the core
tient usually fears that these needs and feelings self.
might be so intense that they will destroy the Remember that resistance to awareness and
self and the therapist. The patient is also often contact was necessary for survival and may
terrified that his or her ego will break down as still be. Respect it and bring it into awareness
the self is experienced more fully. The experi- as something to be accepted. With this aware-
ence of no intimate human relatedness and the ness comes a choice that the patient did not
accompanying experience of being utterly have previously.
alone is understandably terrifying. It is often Work on integrating parts of the self: desire
experienced as "black abyss." No one in the and dread, active and passive core selves,
schizoid patient's past has understood the true, internal attacker and core self.
core self. In group invite participation but allow the
Thus it is not surprising to find tenacious re- schizoid patient to play a passive role without
sistance at this stage. After all, maintaining bad being pejorative. Follow the patient's lead
internal objects may well seem preferable to about timing. If the patient wants to continue
have no internal objects at all. This is one rea- and feels ashamed of how long it is taking, of-
son that deep trust and foundation work must fer support by acknowledging progress (truth-
be done before deeper working through can be fully only), clarifying what is in process and
both safe and effective. what is next, and normalizing the lengthiness
Two related questions arise for the patient at (truthfully only).
this point: Can the therapist be of more use
than the patient's parents were, and can the pa- Audience Questions and My Answers
tient stand being aware of his or her early, core Question: What kind of contract do you
material? make for continuing therapy with schizoid pa-
tients?
Additional Guidelines Answer: I don't make explicit contracts. I
Relationship. Build support for good bound- work in a here-and-now mode so I'm not sure
aries and good contact. Provide a safe environ- how to answer that question. I try to be as
ment. Watch for the twin dangers of intrusion straightforward as I can about what can be
and abandonment. Do not do what the patient done in therapy and how long it takes. It's the
experiences as intrusive—not even in a good only way I know to work with what is emerg-
cause. Needless to say, abandonment is not a ing rather than with something preset.
good thing. Be contactful, emotionally direct Question: Transactional analysts use con-
and open, and easygoing. Let the relationship tracts, particularly in groups. Everyone has a
build with time, caring, and acceptance. Be in- contract, and group members all know what
viting but not intrusive. The goal is contact, not contracts the other members have. When some-
moving the patient somewhere. Identify and one new joins the group, that person struggles
validate the patient's experience using em- to decide what his or her contract is. I've ex-
pathic reflections. Let it be OK that trust builds perienced schizoid patients repeating the same
gradually and that movement is slow. contract for years, and I'm wondering if
Contact the hidden, isolated core self. The you've dealt with that.
patient needs the therapist to contact the pa- Answer: I guess it would be appropriate to
tient's core self so that he or she can feel like ask the person what he or she wants to focus
a person. The schizoid patient cannot do this on and to get out of the group—or out of in-
for himself or herself. The trick is to do it dividual therapy. That may be the rough equiv-
without being intrusive or confrontive. This is alent of a contract. But if everybody else in
done by good contact, experiments and reflec- group has a contract, I'm not sure how I would
tions, and a steady, inviting presence. Cathartic handle that. I would not want to single out a

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“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

schizoid patient as being too defective to have within an emphasis on the relationship, are not
a contract. used to avoid patient-therapist contact, are
Question: What are some of the less obvious arranged mutually by therapist and patient, and
cues for connection and disconnection? do not become an end in themselves.
Answer: Eye contact, change of facial color, Question: More on contact and distancing:
muscle tightening. There's a subtle increase in As you observe the cues you mentioned, how
the quality of connecting in the eyes with a do you avoid the paradox of pointing out con-
connection. With disconnection, the energy tact and the patient feeling intruded on or
moves away, the color in the face changes, and pointing out distance and the patient feeling
often the breath is held. There are also cues in some kind of abandonment?
the flow of speech, especially in fluency. The Answer: Or feeling criticized merely because
stream of talk becomes blocked or disrupted of the observation. 1 don't think you can avoid
when the patient disconnects. that. I try to be careful with my own self-
Question: Please say something about the awareness and not deceive myself about what
gestalt techniques that you use with schizoid I am actually feeling and doing. Am I really
patients and how they differ from traditional trying to connect with what is emerging, for
psychoanalytic approaches. example, the distance issue, or am 1 feeling
Answer: First, I'd be careful about tech- judgmental or aiming at changing the patient?
niques, including gestalt techniques. I would I try to notice what happens when I make an
lead with the paradoxical theory of change, observation. If the patient feels criticized and
although many gestalt therapists don't operate I can be open to that—and not have to defend
that way. They pull up the empty chair or the my honor as a therapist, so to speak—then I
pillows to pound without regard to what's hap- can work with the patient feeling intruded on
pening in the relationship. 1 do not advocate or feeling I'm watching them so closely that
that at all. they're like a bug on a board. 1 pay particular
Gestalt experiments that are more interper- attention to the context and to the subtext of
sonally contactful are more suitable for schiz- how I made my observation. If I am tense, off-
oid patients than the empty chair. This would handed, sarcastic, flat, and so on it may be
include, for example, experiments that in- relevant to why the patient feels intruded on.
volved looking at you (or others in a group) You work with the patient's experience openly,
and maintaining good breathing. Experiments without assuming you are not a part of the
that involve exploring distance can also be use- problem. If you are open, the patient will pick
ful, for example, moving close and then away. up your openness in exploring the interaction
One can either move around the room in doing between him or her and you. If the therapist is
this or change the position of chairs: "How do not defensive and is open, the interaction can
you feel if I move closer?" Then you observe be useful, and a breach in the relationship or
to see what the patient does, for example, if he safety can often be repaired. And in the repair,
or she wants more distance: Does he or she there is often growth such that the relationship
push me away? Signal me away? Take no ac- and the patient are stronger.
tion? Supporting the feeling and movement Often what emerges is that the exposure the
with good breathing is crucial. When it be- patient feels on hearing the therapist's observa-
comes spontaneously obvious that there is an tion triggers shame in him or her. This must be
internal conflict one can experiment with an explored and respected. The therapist must
internal dialogue between the parts using two take responsibility for being part of that pro-
chairs or other forms of role playing. I have cess. However, you can't be too careful about
also done this kind of exploration using psy- trying to avoid such risks and still be an effec-
chodrama techniques rather than the empty tive therapist. We can only be sensitive, aware
chair. I don't use a lot of techniques, but they of the context, our patients, our mood, and how
can be useful in this way—as long as they are we are present, and be willing to repair.

Transactional Analysis Journal, Vol. 31, No. 1, January 2001 22


“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef

Question; I believe you said schizoid pa- Gary Yontef, Ph.D., FAClinP. is a Fellow of
tients often feel humanly connected while in the Academy of Clinical Psychology and a
isolation without being.. . . Diplomate in Clinical Psychology (ABPP).
Answer: Unfortunately they don't. They Along with Lynne Jacobs. Ph.D., he co founded
want and need to feel humanly connected and codirects the Gestalt Therapy Institute of
while they are separated. They will often sub- the Pacific, a contemporary gestalt therapy
stitute being connected symbolically—for ex- training institute. He was formerly president of
ample, in dream imagery or fantasy. the Gestalt Therapy Institute of Los Angeles
Question: For 11 years I worked with a se- and for 18 years headed its training program.
verely schizoid patient who was diagnosed as He is an editorial member of The Gestalt
an extroverted schizoid. He had such a strong Journal, editorial advisor of the British Gestalt
need to be in contact and community that it Journal, and chairman of the Executive Board
appeared as an "as if self. But internally there of the International Gestalt Therapy Associa-
was this severe schizoid process going on, and tion. His book, Awareness, Dialogue and Pro-
I had to work hard to undo that extroverted cess: Essays on Gestalt Therapy, has been
quality—in the Jungian sense that he came into translated into four languages. He has also
the world with that innate extroverted self. written over 30 articles and chapters on ges-
What do you think about such an individual? talt therapy theory and practice. He was for-
Answer: I don't know about the innate self merly on the UCLA Psychology Department
from the Jungian standpoint. One of the ways faculty and chairman of the Professional
that people with schizoid issues often present Conduct Committee of the Los Angeles County
to the world is with extroverted behavior, with Psychological Association. Please send reprint
schizoid processes underneath. Often I am sur- requests to Dr. Yontef at 1460 7th St., Suite
prised at how much shame and schizoid pro- 301, Santa Monica, CA 90401-2632 or contact
cess can be found in people who appear to be him via email at gyonlef@bigfoot.com.
very extroverted. They will experience this
themselves, with surprise, when they get to a REFERENCES
American Psychiatric Association (1994). Diagnostic and
deeper level of awareness. 1 see a lot of the
statistical manual of mental disorders (4th ed.).
schizoid process underlying apparently extro- Wash-
verted, hysterical, dramatic behavior. That is ington. DC; Author.
part of why some people think that the schizoid Beisser, A. (1970). The paradoxical theory of change. In J.
Fagan & 1. L. Shepherd (Eds,). Geslalt therapy now:
process underlies everything. Even extroverts Theory, techniques, applications (pp. 77-80). Palo Alto,
who make good social contact reveal schizoid CA: Science and Behavior Books.
issues when you get to an intimate level with Buber, M. (1965a). Behveen man and man (R. G. Smith,
Trans.). New York: Macmillan.
them or get beneath the words. Buber, M. (1965b). The knowledge of man: A philosophy
Richard Erskine (moderator): I appreciate of the interhuman (M. S. Friedman & R. G. Smith,
the broad theoretical overview you have of- Trans.). New York: Harper & Row.
Buber, M. (1967). A believing humanism: Gleanings(M.
fered us, Gary, and how much you have con-
S. Friedman, Trans.). New York: Simon & Schuster
densed into this short presentation. To summa- Ountrip, H. (1969). Schizoid phenomena, object
rize a bit, I think perhaps one of the most im- relations and
portant things you have been saying—and the self. New York: International Universities Press.
Hycner. R., & Jacobs, L. (1995). The healing relationship
something that needs to be emphasized—is in gestalt therapy: A dialogic self psychology. New
that the schizoid process is often not observ- York: Gestalt Journal Press.
able. Frequently, schizoid patients present as Lee, R., & Wheeler, G. (1996). The voice of shame:
Silence and connection in psychotherapy. San Fran-
highly functioning individuals, and it is only
cisco: Jossey-Bass.
through phenomenological experience that they Stem, D. N. (1985). The interpersonal world of the infant:
and we come to understand and appreciate the A view from psychoanalysis and developmental psy-
schizoid processes that underlie so much of chology. New York: Basic Books.
Yontef, G. (1993). Awareness, dialogue and process:
their lives. Essays on gestalt therapy. New York: Gestalt Journal
Press.

Transactional Analysis Journal, Vol. 31, No. 1, January 2001 23

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