Psychoanalytic therapy for treating psychosis?

Please could someone explain to me why many people are against the idea of treating psychosis with psychoanalytic therapy? Does anyone have an opinion on this?

I think one reason is because, these days, psychosis is most often considered a biological/physical condition that should primarily be treated medically (and there are effective medications). Another one is that psychoanalytic therapy can sometimes generate a lot of confusion and turmoil which, in combination with active psychotic states, might make the condition worse. And many people in the mental health field also believe that psychoanalytic therapy may not be useful at all if the perception of reality is not sufficiently intact in a client.

There was this psychiatrist guy called Hyman Spotnitz who ventured into treated psychotic illness in the mid/late 20th century purely with a form of analytic therapy that he developed. This is his seminal work on it:
https://www.amazon.com/Modern-Psycho.../dp/0970392362

In the book, it is described that the original Freudians did not believe that conditions like schizophrenia could be treated with psychoanalysis because they thought people with psychotic conditions do not develop an object transference, which was believed crucial for successful analysis. Spotnitz describes an alternative in the book.

My first therapist (a psychoanalyst) was very strongly influenced by Spotnitz's work. It wasn't relevant to my therapy so can't share personal stories but there are still people who believe in it.

Inadequately treated psychosis - that is, psychosis that is allowed to fester for years - is not only disabling but can result in long term consequences. For example, when schizophrenia is not nipped in the bud early on, people do not tend to be able to go on and live relatively normal lives even once the psychosis is under control. Their thinking is forever changed and it's as if there is some sort of cognitive damage that occurs that cannot be reversed. There is actually also such a thing as psychosis-induced PTSD. I think it is very dangerous indeed to risk treating someone suffering from psychosis with psychoanalysis instead of medication. There is also the fact that psychoanalysis isn't even for everybody and I think it actually requires a lot of inner strength. That is not to say that people afflicted with psychosis don't have inner strength, but that they are already carrying a significant mental burden that I think would make psychoanalysis contraindicated. Finally, I would like to point out that outcomes for people with psychosis have improved as medication has replaced other treatments, including psychoanalysis, as the treatment of choice. Yes, anti-psychotics have a lot of drawbacks. They tend to be very sedating and make people fat. However, when psychosis is treated early and adequately with medication, symptoms can be controlled and are not so disabling that they define a person's life.

So yeah, psychosis is really the only mental condition that I unequivocally feel medication is always the best course (at this time). With other things, trying alternative treatments first can sometimes be a waste of time or result in social and occupational losses, but short of the risk of suicide (which can happen medicated, as well), there's not the same kind of irreversible damage that I've seen in people who were either not medicated for a long time when they first got sick, or who have periods when they don't take their medication.

I see you are UK based. You might be interested to read about the work and approach of Rufus May, if you aren't already familiar with him. He is a clinical psychologist who was diagnosed with schizophrenia and he advocates non-medicinal approaches to managing the symptoms of psychosis. From memory, he doesn't advocate psychoanalysis specifically, but certainly believes that psychosis can be treated outside psychiatric services.

I think the ideas that psychosis is too complex to treat with anything other than medicines or that people experiencing psychosis are too unwell to be in alternative therapies are outdated. When I was in a period of recovery from psychosis, I started Jungian influenced therapy. My therapist would often say that psychotic clients can successfully engage in therapy since many delusions have their roots in archetypal thinking. Delusions have their own sense and psychotic clients are capable of accessing that meaning, indeed are probably best-placed to access that meaning when unwell.

Rufus May – Holistic approaches to mental health
Rufus May - Wikipedia

I very much agree with susannah. The best approach would be to be thoroughly evaluated by a medical team - not just a psychiatrist but also medical tests in order to rule out other possible causes, as some physiological conditions that are not primarily psychiatric can also cause psychotic symptoms, as well as extreme stress, drugs etc, in vulnerable individuals. If alternative causes are ruled out, I would definitely start with a medication regimen prescribed by a psychiatrist, considering all known individual factors, possible dual diagnoses etc. And then (or simultaneously) maybe try a form of psychotherapy. I think there are quite a few people here on PC with schizophrenia, schizoaffective disorders, severe bipolar (which can also produce psychosis) etc who are on medication and also see a therapist, or at least tried different combinations of treatments. Definitely the earlier start of exploring appropriate treatment the better.

If the voices don't go away on medication, I would try doing therapy while on medication. I don't know how long you have been off your medication, but it is certainly concerning that you are feeling paranoid and believe the voices have a will of their own in that they are trying to tell you something. I understand your point about masking the problem with drugs, however, I think your condition is likely to deteriorate should you choose to stay off of your medication. I think your current clarity of thought is likely transient and will be subsumed by psychotic symptoms as time progresses.

You could try cbt for psychosis, it’s not as effective as medication but can work with lower doses of APs.

What is your actual diagnosis? Is it schizophrenia or something else (have you been evaluated for different psychotic conditions)?

Paranoid schizophrenia and personality disorder.

I am guessing this is outpatient treatment? Is there any chance to find a psychiatrist who also does therapy? I would definitely suggest that, or to approach the psychiatrist who prescribes the Clozapinine for referral to recommend a therapist, and try that. You can actually suggest psychoanalytic elements in your therapy as you seem quite knowledgable and present.