Psychotherapy in cases of damage to the central nervous system.

With reference to case histories, the authors (a psychotherapist and a neurologist/pediatrician) illustrate a joint project undertaken in the framework of an integrated approach to medical care. In their view, management of the exchange of information is the central problem requiring proper understanding if the treatment of patients in a coma or in other extreme existential situations is to have prospects of success. In the project, the management of information exchange was realized formally by the introduction of an ongoing therapeutic matrix, enabling the clinical phenomena to be interpreted both as the expression of a defect in the organism (symptom) and as a token of a disturbance in the relation between organism and environment (sign). After conclusion of the project, the essential results were as follows: (1) all coma patients had a complete coma remission, although this appeared improbable on the basis of medical prognosis criteria alone; (2) in all of them, the time required for regaining consciousness was reduced to about one-third of the period anticipated on purely statistical grounds.