Released in Shackles AMA from the Hospital for the Criminally Insane

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Length: 30 minutes

Ira Steinman, MD

An over-riding principle of the presenter’s psychotherapeutic approach is that Intensive Psychotherapy of Psychosis, emphasizing unconscious motivation, transference, counter-transference, resistance, and interpretations of these factors, is very useful, sometimes curative, in an out patient practice. But what of the usefulness of such an inquiring psychotherapeutic approach with an in-patient?

Jill appeared on the presenter’s doorstep, replete with family and a guard, having been released to his office against medical advice from a hospital for the criminally insane on court order. It was the first he had heard about her.

She had been in the hospital for three years, loaded up on tremendous amounts of antipsychotic and mood stabilizing medications, in an attempt to keep her from attacking staff members during paranoid and hallucinating rages. He debated whether or not to see such a patient out of the hospital, but did so when the family made the compelling argument that things hadn't gotten better in three years in the hospital.  They asked if he could talk with her in his office.  He did.

They quickly uncovered the transference source of the paranoia, hallucinations, rages and attacks upon staff members, leading to a marked improvement in her condition, vastly less antipsychotic medication, and a return to living in her community out of the hospital.

Yet again, Intensive Psychotherapy of Psychosis prevailed, where three years of previous hospitalization and huge amounts of antipsychotic and mood stabilizing medication left the patient in a confused and incarcerated morass.

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