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This paper describes some basic problems and assumptions in supportive psychodynamic psychotherapy with persons in states of psychosis. It starts out by addressing changes in the views of science - from the case study method to the evidence-based medicine paradigm - and continues with a discussion of the necessity for psychotherapy integration and conceptual clarification in delineating psychodynamic psychotherapy in the field of psychosis. Over a period of decades a small number of comparative studies have been conducted in which psychodynamic psychotherapy of patients with schizophrenia has been compared with treatment as usual. The latest of these, a Danish prospective multicentre study, is described. Some basic arguments for calling this study ‘psychodynamic’ and ‘supportive’ are outlined, and a few overall aims are described, including the desired abilities of the therapists in this particular field. Even though the use of randomized controlled trials, scientifically, is a difficult paradigm for psychodynamic psychotherapy, studies like the Danish one support the use of psychodynamic treatment in the National Health Service.