Psychoanalysis and psychoanalytic psychotherapy have been used to help neurotic patients by enlightening them about their unconscious psychology, its dynamic content and process. The treatment of psychotic states is different from that of neurotic states because the psychoanalytic psychotherapy and psychoanalysis of psychotic states must deal with ego dysfunction. This chapter describes the techniques of treating specific ego deficits. The fact that patients can have an observing ego about their psychosis leads to the distinction between observing ego and reality testing and the hypothesis that observing ego and reality testing are two separate ego functions. The symbolic alteration of reality is the manifest, conscious, and easily recognizable manifestation of psychotic structure and its primary processes. The subject of regression and of psychotherapy versus psychoanalysis usually brings up the issue of the couch. As therapy progresses, the relationship of the ego to superego as it affects self-esteem is often a crucial issue.