Phases in Individual Psychotherapy for Paranoid Disorders

Abstract

For a very long time paranoia was considered to be a contraindication for individual psychotherapy, and the dynamic operations that lie at the basis of the paranoid process were in fact thought to be unreachable. This paper is an attempt to systematize years of experience involving the psychotherapy of the paranoid. We will outline the specific problems that occur while working with these patients. The process of psychotherapy stems from an understanding of the development of the paranoid process, its mechanisms and phenomenological expression. We will show all the crucial moments of individual psychotherapy which determine the phases of the therapeutic process. The first phase incorporates the following: establishing a therapeutic agreement, the creation of an initial therapeutic alliance and its transformation into a genuine therapeutic alliance. The second phase incorporates the following: uncovering the defensive nature of the paranoid construction, which requires a series of intermediate steps such as: undermining the projected system and paranoid defenses, defining and explaining the introjective configuration, an explanation of the origin of the introjective configurations and so on. During the final phase of the separation, we can consider the termination phase of the treatment or can decide to leave the therapeutic process open.