From Breakdown to Breakthrough

Psychoanalytic Treatment of Psychosis

By Danielle Knafo and Michael Selzer

This book, a clear and user-friendly guide for clinicians who work with patients affected by psychosis, challenges the false notion that psychosis is untreatable through talk therapy.

The authors contend that since psychotic symptoms are features of survival adaptation, they naturally serve as a valuable source of information, providing clues about the origins of people’s psychic derailment along with a path to its cure. The authors advise therapists not only to read and respond to the messages embedded in the symptoms, but also to recognize and utilize the non-psychotic aspects of the patient in facilitating recovery.

The overall aim is to recruit the patient as a collaborator in their treatment, thus wresting a meaningful and redemptive narrative from the psychotic experience. All aspects and phases of treatment – from initial encounters through the middle phase to termination, and even supervision – are covered in this volume.

Abundant with clinical examples, theoretical and technical points, and treatment methods, this book is essential reading for all psychotherapists, psychoanalysts, and other mental health clinicians working with psychosis.


While reading this volume, my highlighting pen rarely left my hand, so much was there to note and remember. With clarity and style, the authors thoroughly refute the despairing deficit model of psychosis by offering a brilliant theoretical synthesis and practical approach to understanding and responding to the language of psychosis. Their powerful arguments are given felt resonance through many poignant case histories. This book is a victory for the psychoanalytic treatment of psychosis, and I found myself applauding nearly every page. All mental health practitioners, especially early career psychotherapists, will be greatly helped in knowing how to treat those deemed unreachable as they learn to decipher and work with symptoms as forms of communication.
–Francoise Davoine, Ph.D., French psychoanalyst and co-author of History Beyond Trauma

This book is a passionate, responsive, and highly educated exploration and sharing of psychological work with psychosis, emphasizing intricacies of the therapy relationship, its nuances and possibilities.Psychoanalytic, psychodynamic, and relational perspectives open doors of contact, healing, and growth. This book is a beautiful exposition and affirmation of ways the human spirit connects with difficult, often seemingly intractable, states as it supports and mediates transformative processes.
–Michael Eigen, Ph.D., is a psychoanalyst and author of The Psychotic Core

This is a terrific book! Knafo and Selzer are master clinicians who work with the skill, determination, patience, and grace required to give patients who are in psychological retreat from consensual reality an opportunity to risk re-entering a world they came to find too difficult to bear. The authors present a persuasive case for regarding psychotic symptoms as essential sources of information  that provide a foundation for the patient’s treatment.  They illustrate their approach with many clear and moving clinical examples. They share their intuitions, formulations, and decisions as their work unfolds with individual patients. The book is full of clinical wisdom, important ideas, and practical advice. It is certain to be of value to experienced clinicians and early career psychotherapists alike.
–Michael Garrett, MD, psychiatrist, psychoanalyst and author, Psychotherapy for Psychosis

This wonderful book, based on extensive knowledge and experience, illustrates effective alternative approaches to the medical model to assist persons who suffer psychosis to achieve a fuller life. Both novice and veteran mental health professionals cannot fail to gain useful insights from any of the chapters as will persons with experience of psychosis and family members. The book is written in a style that will readily engage the reader and, in doing so, also demonstrate much better ways of engaging with one’s patients.
–Brian Martindale, MD, psychiatrist and psychoanalyst in the UK, past president of the International Society for the Psychological & Social Approaches to Psychosis (ISPS)

From Breakdown to Breakthrough is a remarkable, thoroughly researched and compellingly argued, book that every clinician who works with psychotic patients and every student who is assigned treatment of such patients would be well-advised to read….It also provides answers to a wide range of questions regarding the understanding and treatment of patients who are otherwise considered incurable. …The authors offer a forceful model of working with psychosis which diverges from the current practice that is based on the hegemonic medical model….Instead of seeing symptoms as signs of pathology, dis-ease, or dis-ability, they see and wisely interpret them as creative attempts on the part of their patients to adapt and survive.
–Orna Ophir, psychoanalyst and author, Schizophrenia: An Unfinished History and Psychosis, Psychoanalysis and Psychiatry in Postwar USA