A psychotic dilemma: psychodynamic group therapy for patients with schizophrenia in times of crisis.

Introduction: Psychodynamic group therapy (PDGT) for schizophrenia offers a therapeutic space where patients can explore conflicts considered pathognomonic for the disorder. This study examines the role of PDGT during a crisis, focusing on psychotic dilemmas as described by Mentzos while also exploring the relevance of psychodynamic psychosis theory in ensuring effective psychotherapeutic care. Materials and methods: Using qualitative content analysis, we analyzed transcribed audio recordings of therapy sessions during the COVID-19 pandemic. Thematic categories were inductively developed and examined within Mentzos' psychodynamic framework. Results: Four key themes emerged: (1) Loss of something meaningful, reflecting existential fears intensified by the crisis; (2) Paranoia, manifesting as distrust toward external structures; (3) Care and self-care, illustrating oscillations between autonomy and dependence; and (4) Closeness and distance in relationships, highlighting struggles of relationship formation, especially in times of rigid social boundaries. These themes mirror the psychotic dilemmas identified by Mentzos, reinforcing their relevance in crisis settings. The findings suggest that PDGT enables patients to explore these dilemmas and negotiate interpersonal conflicts. However, the crisis environment led to therapy disruptions, impacting group cohesion and participation, likely exacerbating symptoms in some patients. Conclusion: Psychodynamic group therapy is crucial in supporting patients with schizophrenia, especially during crises, by enabling engagement with core conflicts through relationships rather than symptom formation. However, maintaining therapeutic continuity remains a challenge. Future research should examine group cohesion in various crises and its link to delusional symptoms, as well as strategies to stabilize group therapy and expand PDGT access internationally.