Cautiously supportive accompaniment and supervision
of the patient is above all necessary in the run up to first
episodes of a schizophrenic psychosis, though also in the
case of each renewed exacerbation. By means of an empathic
and stoically enduring therapeutic approach, the
attempt must be made to build up a stable and sustainable
therapeutic relationship, despite alternating ambivalence
on the part of the patient (table 3).14 Within such
an approach, there are no clear, down to the very last detail,
standardized procedures; even though much the
same psychological principles are valid in interacting
with schizophrenic individuals as with nonpsychotic
patients, it is important to bear in mind that unexpected
and initially illogical appearing reactions can occur in
light of the patient’s psychotically altered perception of
the surrounding environment. Under the paradigm of
‘‘double-entry book-keeping,’’ it is, however, possible
for the majority of those afflicted, despite neither feeling
ill nor really possessing insight into the illness, to accept