ABSTRACT
In patients who are chronically delusional or schizophrenic, and have been so for many years, psychotherapy has many phases. First there is an attempt to assess the situation and see when the psychotic material began. Defences — movement, dissociation, projection, distraction, displacement, to name a few — are primary in any psychotherapy of delusional states. These defences seem necessary from the patient’s point of view. It lies at the heart of all dynamic psychotherapy and requires the understanding on the therapist’s part that patients have unconscious motivation and resistance to change, and that they have defences to maintain the status quo, painful as it is. With the deciphering of delusions and the symbols contained in delusions, hallucinations, and the schizophrenic orientation, feelings and emotions which have been dammed up for years will flow, often with a terrorising effect for the patient.
