Interest in psychotherapy of the psychoses has waxed and waned. Freud (1953a, b, c) disagreed with Bleuler (1912) and lung (1972) in their suggesting an organic aetiology of schizophrenia although he conceded that such a view did not exclude his own libido theory. Nevertheless Freud considered psychoses unsuitable for his new treatment.

Indeed during the years of high psychotherapeutic optimism, and preceding the widespread understanding and application of antipsychotic medication, considerable advances were made in intensive psychotherapy with schizophrenia, e.g. Fromm-Reichmann (1950) and Arieti (1955). Nevertheless during the past few decades psychotherapy has fallen into considerable decline as an important component in the long-term treatment of functional psychoses. Indeed the feelinghas grown up that psychotherapy in these patients has negligible or even harmful effects. More often it is ignored as a treatment in this context (Wing & Wing, 1982).There has been a considerable renewal of interest in studying the effectiveness and efficiency of psychological treatments in psychiatry (Strupp & Bergin, 1969; Malan, 1973; Daly, 1981). In fact London & Klerman (1982) have made a plea for the urgent setting up of a national body in the United States, similar to the Food and Drugs Administration, to evaluate and regulate psychotherapies. They point out that psychotherapy costs in the United States are in excess of $1000000000, comparable with the expenditure on pharmacological treatments. In my own Health Board, the costs of paying personnel in mental hospitals exceeds the bill for medications by a large factor. Thus there surely is considerable justification for examining what these expensive personnel do and say during their encounters with schizophrenic patients, and what effect this mayor may not have on the course of the illness of those suffering from chronic psychoses.