Clinicians and researchers have grappled for many years with the puzzle of negative symptoms. Negative symptoms have also proven remarkably resistant to pharmacological treatment, and therapeutic pessimism abounds both in individuals debilitated by these very unpleasant symptoms and in clinicians. Crow tried to relate positive and negative symptoms to different underlying pathological processes: negative symptoms to structural brain abnormalities and positive to increased dopamine receptors. The bradykinesia and other abnormal movements observed in people on long-term neuroleptic medication have raised concerns about the possibility of some negative symptoms being directly caused by medication. As with cognitive-behaviour therapy in other conditions, assessment of the patient should lead to a preliminary formulation. This will enable a discussion about useful short-term goals for therapy planned to test hypotheses generated in the formulation.