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In this paper, I discuss the treatment of a severely alienated young man diagnosed as schizoid. After two years of treatment in which some progress occurred, he developed a delusional system that appeared to be a tightly closed circle of interwoven thoughts. In this delusion a worm, having gotten into his brain through one of his eyes, was slowly eating his brain away, and there was no hope in his view that he could do anything, because at any moment he might be completely destroyed. Unless I could prove to him 100% that there was no way a worm could get into his eye, he could not go on. After several months of work in which I attempted to understand this development, the patient remained convinced that the worm was there. He began to deteriorate further. I found myself as despairing as he was.
We remained entangled together until I realized that my basic attitude of wanting to understand the symptom also contained my desire for the patient to get rid of this most painful and puzzling symptom. Until I shifted my position to one of deeper acceptance of the patient's reality, I could not help him. It is my view that with a psychotic patient it is not enough to understand the symptom; in fact, analysis and understanding may at some points impede progress. Acceptance is an important part of healing with any patient, but with a psychotic patient the therapist must find a way not only to accept the patient's reality, but to enter into it with him. Communicating acceptance may involve making contact with the patient in an active way.
Victor, at age 19 had persisted in seeking help through several hospital clinics, when he was referred to me at an outpatient clinic. He was gaunt, haunted looking, extremely thin, with unkempt dark hair. The problem he presented was that after taking several LSD trips he had found he could play the guitar very well. However, whenever he would start playing he would become obsessed with the thought that something could happen to take this abilit