«The other comes first»: the idea of relational trauma and other concepts by Zefiro Mellacqua for the treatment of Schizophrenia and Schizophrenia Spectrum Disorders

In the present article the authors reviewed the concepts and models proposed by a certified transactional analyst in psychotherapy, psychiatrist, Dr.Mellacqua Zefiro, who has spent many years researching ways to alleviate schizophrenic sufferings. In 2024, Dr. Mellacqua was awarded the Eric Berne Memorial Award for his contribution to the theory and practice of Transactional Analysis. The authors of the article highlight three key ideas of Dr. Mellacqua: relational trauma, double splitting and the body as a theatre of the unconscious in transference/countertransference analysis. In this article relational trauma is considered to be one of the important predictors of early self-fragmentation and ego disorganisation, contributing to the development of psychopathology and ego sufferings of individuals with Schizophrenia Spectrum Disorders. Dr. Mellacqua’s concept of double splitting (vertical and horizontal) offers an explanation for personality structure fragmentation and disorganization. This concept gives greater therapeutic opportunities for working with clients with Schizophrenia Spectrum Disorders. Transference and countertransference analysis provides a chance to «see» the client through the theater of his (the clientapos;s) and yours (the therapistapos;s) bodily expressions, and build the therapeutic process taking into account these representations.