Psychotherapy Volume 38/Fall 2001/Number 3 SCHIZOPHRENIA AND THE COLLAPSE OF THE DIALOGICAL SELF: RECOVERY, NARRATIVE AND PSYCHOTHERAPY PAUL HENRY LYSAKER Roudebush VA Medical Center and the Psychiatry Department Indiana University School of Medicine, Indianapolis, Indiana JOHN TIMOTHY LYSAKER Department of Philosophy University of Oregon, Eugene, Oregon JUDITH THOMPSON LYSAKER Department of Education Butler University, Indianapolis, Indiana Personal narratives are the stories people tell to themselves and others to place daily experiences in context and make meaning of them. They connect past to future, bringing together remembered and felt experience, lending coherence and structure to the foundations of identity. In schizophrenia, however, personal narratives often appear to have lost their synthetic power. Phenomenologically speaking, how do personal narratives disintegrate in schizophrenia, and how should narrative issues in schizophrenia be addressed in individual psychotherapy? To examine these issues, this article presents a case analysis suggesting that narratives in schizophrenia are compromised when internal dialogue either dissolves into a cacophonous disarray or becomes too singularly and rigidly organized. We suggest, therefore, that one way psychotherapy may be useful to persons with schizophrenia is to facilitate the Correspondence regarding this article should be addressed to Paul Lysaker, Ph.D., Day Hospital 116H, 1481 West 10th St., Roudebush VA Medical Center, Indianapolis, IN 46202. E-mail: Lysaker.Paui_h_phd@Indianapolis.va.gov reemergence of internal dialogue through external dialogue. In particular, psychotherapy can assist persons with schizophrenia to develop a narrative that allows for recovery by creating a context for increasing self-awareness, and agency. We propose that, in the midst of the ongoing development of numerous and effective psychosocial treatments for schizophrenia, the ability to facilitate narrative coherence may represent a unique psychotherapeutic contribution to recovery for persons with this condition. Despite being actively practiced (Fenton, 2000), individual psychotherapy for schizo- phrenia is not commonly mentioned in the liter- ature except as a loosely defined, supportive case-management task (e.g., Wolff et al., 1997), or as a control condition in studies of other interventions (e.g., Hogarty et al., 1997). This seems a loss given that many with schizo- phrenia report that they have found psychother- apy helpful (Coursey, Keller, & Farrell, 1995; Hatfield, Gearson, & Coursey, 1996) and that case studies (Lysaker & France, 1999; Lysaker & Lysaker, in press) and some quantitative re- search (Glass et al., 1989; Gunderson et al., 1984) suggest psychotherapy has benefits for persons with schizophrenia. Perhaps one reason why psychotherapy has been neglected is that as more and more psy- 252 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.