All the king's horses and all the king's men. Three forms of curative audience in the recovery from psychosis.
This essay discusses an overlooked ingredient in the psychotherapy of psychosis which is termed the "curative audience." Central to the equation of psychological selfhood is the evocation of a sense of self by experiences that the patient has with objects in the environment. This essay calls attention to an essential function of this environment, namely, that it provides an audience that makes it possible for these "selfobject" transferences, transference interpretations or new, helpful relational experiences to become significant. In essence, it is argued that a "private experience" without an internal or external audience is not therapeutic in the reassembly of self, especially when the power and intensity to overcome psychotic disintegration is required. The idea that the psychotic patient recompensates not only with the help of a therapist but under the auspices of a third entity, has not been previously discussed. Interestingly, all the schools of psychoanalysis have touched on the role of audience in the healing of patients with both neurosis and psychosis, yet this thread has not been followed into its binding together of subjectivity. Three forms of curative audience can be identified corresponding to the beginning, middle, and end phases of treatment. The role of audience in the reassembly of the self is taking its first form in the initial contact or initial relationship with the other and over time develops into the second form, the therapeutic alliance. In the third form of the curative audience, the establishment of an external selfobject milieu that performs the functions of the curative audience is seen as essential to continued cohesion in the recovery from psychosis. Performative statements exert self-cohering effects and can be seen to have their source in the curative audience. Two clinical vignettes were presented to illustrate these ideas.
Garfield
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Department of Psychiatry and Behavioral Sciences, Finch University of Health Sciences, Chicago Medical School, IL 60064, USA.
D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy; D003702:Delusions / Q000523:psychology / Q000628:therapy; D004532:Ego; D005260:Female; D006801:Humans; D008297:Male; D009769:Object Attachment; D011573:Psychoanalytic Interpretation; D011575:Psychoanalytic Therapy / Q000379:methods*; D011618:Psychotic Disorders / Q000523:psychology / Q000628:therapy*; D012931:Social Environment; D014167:Transference, Psychology