ABSTRACT
Occasionally a markedly delusional patient comes along who is both so intelligent and so intractably paranoid that the best that can be hoped for in the course of a short-term psychotherapy is a type of therapeutic impasse. Where the patient saves face and insists on the correctness of his paranoid beliefs, while clinical improvement occurs. Such a stalemate is unsatisfying for the therapist, but may be of crucial help to the patient in terms of work, relationships and involvement in life. Peter was a lonely, isolated young man in his late twenties, and had a far-flung delusional system revolving around Harold Geneen. He spent a year in once to twice weekly psychotherapy, with one short hospitalisation. The important lesson was that a psychotherapy which appeared to be stalemated and going very slowly helped a delusional man reorganise to the extent that he was able to go on and function.
