SYMBOLIC REALIZATION

Symbolic realization is a psychoanalytically-inspired technique that is used in psychotherapy with schizophrenic patients.

In 1947, in a supplement to the Revue Suisse de psychologie et de psychologie appliqué, Marguerite A. Sechehaye (1887-1964), a psychoanalyst in Geneva, described the technique in the article: "La realization symbolique: Nouvelle méthode de psychothérapie appliquéeà un cas de schizophrénie (Symbolic realization: A new method of psychotherapy applied to a case of schizophrenia). In 1950 the patient's own account of her illness and treatment was published, as she described them to her therapist. It was accompanied by a psychoanalytic interpretation of how the therapy developed (Sechehaye, Journal d 'une schizophrène [Autobiography of a Schizophrenic Girl]).

Symbolic realization is a psychotherapeutic technique that combines the active support of the psychotherapist for the psychotic patient (this implies adjusting the frame) with interpretations of the patient's unconscious fantasies in terms of libidinal development. This approach is based on the importance Sechehaye accords to real frustration in the disintegration of the ego, which lies at the root of schizophrenic psychosis. It follows from this perspective that the role of the therapist is to seek to satisfy the fundamental needs of the patient and repair the initial frustrations not only by interpreting the patient's fantasies but also by establishing a real, even a physical, contact with the patient. This attitude is considered to help the patient to regress in order to be able to progress, resume the interrupted course of infantile development, and thus recover the sense of reality.

This notion, which is akin to that of therapeutic regression (Donald W. Winnicott, Michael Balint), represents a pioneering and original approach to psychotic disorders. However, the active intervention of the therapist in the patient's life in order to satisfy her needs constituted an acting out that was not interpreted as such in a transference the importance of which was underestimated.

Jean-Michel Quinodoz

See also: Sechehaye-Burdet, Marguerite; Switzerland (French-speaking).

Bibliography

Laplanche, Jean, and Pontalis, Jean-Bertrand. (1967). Vocabulaire de la psychanalyse. Paris: Presses Universitaires de France.

Sechehaye, Marguerite A. (1951). Autobiography of a schizophrenic girl; with analytic interpretation by Marguerite Sechehaye (Grace Rubin-Rabson, Trans.). New York: Grune and Stratton.

——. (1954). Introduction à la psychothérapie des schizophrènes. Paris: Presses Universitaires de France.

——. (1957). La réalisation symbolique, un catalyseur de la structuration du moi schizophrène. In Acta psychotherapeutica, psychosomatica et orthopedagologica. Basel.

——. (1970). Symbolic realization; a new method of psychotherapy applied to a case of schizophrenia (Barbrö Würsten and Helmut Würsten, Trans.). New York: International Universities Press. (Original work published 1947)