The treatment of paranoid phenomena: the development of the self

The two main problems of patients suffering from paranoid phenomena are discussed from a treatment perspective. These two problems arising from "having trusted too much" and having lost "ownership of the self" result in the classic projections and loss of initiative commonly seen in paranoid psychopathology. Clinicians must first ward off the patients' projections and help patients work toward a position of "healthy skepticism." This article shows: (1) the specific role of narcissism, its structures and processes, as they contribute to the internal changes needed to achieve this goal; (2) how clinicians can rekindle important sources of initiative and aspiration within the patient. Selfobject relationships, the agency of the ego ideal and the role of the affects of hope and affection, along with such specific interventions as "performative statements," have been offered as helpful tools for clinicians who work with paranoid patients.