Delusions in the transference. Psychotherapy with the paranoid patient

This article has attempted to combine a theoretical and practical approach to the challenge presented in psychotherapy of paranoid and delusional patients. The essential ingredients of psychotherapy of non-psychotic patients--such as the frame, the therapeutic alliance, transference, countertransference, and interpretation--all play roles in the psychotherapy of paranoid, psychotic, delusional patients as well. Differences in defense mechanisms and dynamics and their working through, however, can make unfamiliar the factors that are basic to any psychotherapy. A familiarity with the unique problems of psychotic individuals in psychotherapy may help to make the work less bewildering and frightening, although no less challenging.