Addressing Challenges in Individual Psychotherapy with Delusional Patients: A Case Study

Although cognitive-behavioral treatments for schizophrenia and other psychotic disorders demonstrate strong results in clinical trials, not all patients respond to these treatments. Common challenges in psychotherapy with delusional patients include a mismatch between the therapist’s and the patient’s expectations about the purpose of therapy, the patient’s lack of motivation to reduce delusional beliefs in service of other goals, and the patient’s dependence on the delusions in order to preserve an intact sense of self. This case highlights the value of integrating a psychodynamic perspective with cognitive-behavioral interventions to address challenges in psychotherapy with chronically delusional patients.