“PSYCHOTHERAPY OF SCHIZOID PROCESS” by Gary Yontef Abstract Schizoid process is one of the most ubiquitous personality patterns, but it is insufficiently discussed in the literature. This article offers a description of both the true schizoid and the more prevalent schizoid process that runs through various types and levels of functioning. Schizoid process and personality type are described, including the characterological organization, interpersonal processes, and developmental origins of schizoid process. Therapy of schizoid process is discussed in terms of presentation of the schizoid in psychotherapy, development of the therapeutic relationship, stages of therapy, and treatment suggestions and cautions. The schizoid process is important enough to warrant more attention than it currently receives, partly because, to some degree, everyone experiences some facets of it. Discussions about the schizoid process can clarify issues related to contact, isolation, and intimacy in relation to people with a variety of character styles who operate at levels of personal functioning ranging from normal neurosis through serious character disorders. True schizoids are also fairly common. These are individuals for whom the schizoid process is central to their dynamics and who fit the DSM-IV (American Psychiatric Association, 1994) diagnostic criteria. They tend to be quiet patients who do not cause much trouble or make many demands. If the therapist does not know about the schizoid process and how to work with it, such clients may well be in therapy for a long time without really dealing with their most basic issues. This article is a modified version of a keynote address given on 20 August 1999 at the annual conference of the International Transactional Analysis Association in San Francisco. Psychotherapy of Schizoid Process Gary Yontef In this article I use the term "schizoid" to refer both to the true schizoid and to the patient who functions with significant schizoid processes or defenses but does not fit the full diagnostic picture. Presenting Picture of the True Schizoid The true schizoid usually presents as a loner, someone who is profoundly emotionally isolated, who has few close friends, who is not very close even in "intimate" relationships, who drifts through life, and for whom life seems boring or meaningless. Schizoid patients usually show extreme approach-avoidance difficulties. They often come to therapy because of loss or threat of loss of a relationship or because of relationship difficulties at work. They frequently describe themselves as depressed and tend to identify more with the spaces between people than with interhuman connections. In therapy, as in many of their relationships, they tend to be present but not with vitality—that is, not "in their body" or with their feelings. Schizoid patients tend to come to therapy regularly but do not appear to be engaged emotionally. A common reaction of the therapist in response to a schizoid patient is to become sleepy, even if he or she does not have this reaction with other patients. There is so little human connection during sessions that it is like not having enough oxygen in the room. The first time this happened to me was with a patient I liked. I thought perhaps I was getting sleepy because 1 saw her right after lunch, so 1 changed her hour. But that was not the problem. In fact, 1 never get sleepy with patients —except occasionally with a schizoid patient. The Existential Terror Underneath To people with schizoid character organization, real human connections are terrifying. In their fantasy life and their behavior, these individuals try to live as if in a castle on an Transactional Analysis Journal, Vol. 31, No. 1, January 2001 7