IJSP Number 4, 2022

74 we can identify stress factors and minimize relapse [9]; hallucinations and delusions contain indications of defensive processes and avoided realities. From the perspective of integrative strategic psychotherapy, schizophrenia is characterized by significant changes at all levels described by this therapeutic approach: the biological level, the cognitive axis, the emotional axis, the psychodynamic level and the interpersonal level. As a result of the complexity of psychosis, psychotherapists, especially those in the beginning of their careers, have significant difficulties in working with these patients and in integrating information during supervision sessions. This last aspect is particularly interesting, because it means there is an ov erlap between the schizophrenic patient’s incapacity to integrate information from the surrounding environment and the psychotherapist’s incapacity of integrating information in supervision. 2. The psychotherapist’s difficulties in treating the schizoph renic patient 2.1. Difficulties in maintaining the therapeutic alliance and relationship The treatment of schizophrenia is probably one of the most difficult psychotherapeutic tasks, due to difficulties in building a therapeutic alliance and relationship [11], together with the psychotherapist’s tendency of a “logical approach”. The creation of a therapeutic alliance is the main ingredient of any form of psychotherapy and has paramount importance in the treatment of the schizophrenic patient. Fundamental techniques involve empathy, respect, unconditional regard and sincerity. Ideally, we must accept the patient’s beliefs, feelings and actions, even if they “have no real basis”, and must find out as many specific details as possible about the patient’s exp erience, without contradicting her beliefs, in the same time being careful not to confirm them [7]. In the beginning of therapy, supportive interventions are always preferred because it is important to show the patient that the psychotherapist is a reliable person, who wishes to understand, trusting the patient’s potential as human being. A good therapeutic alliance is a predictive factor for treatment, compliance to treatment and prognosis [7]. Unfortunately, the therapeutic alliance is not easily established with schizophrenia patients, who are reserved and distant, and therefore need a lot of patience and support. In addition, research shows that, in order to create a good therapeutic alliance, we must avoid premature confrontation of the patient’s explan atory model of delusions and hallucinations [7]. When a psychotherapist treats a schizophrenic patient, she often feels uncomfortable, frustrated, sad or angry because the patient does not react the way the psychotherapist would like her to react, and work with the patient seems not to progress at all. Many times, everything the psychotherapist knows seems not to work and may create the sensation that both psychotherapist and patient are caught in a vicious circle, that there is nothing that works with the schizophrenic patient. Other times, the psychotherapist is scared and doesn’t know why. One of the reasons behind this feeling is that the patient herself is scared (unconscious identity). Even if the schizophrenic patient seems not to feel emotions, actually most of them feel terror. People cannot tolerate chronic terror and therefore there