The Feared Therapist: On Being Part of the Psychotic Patient's Paranoid Delusion

Psychosis can be understood as, in part, a disorder of the self. The various factors that contribute to the development of psychosis and the consequences of psychotic symptoms potentially impede the development of the patient's subjectivity, and can lead to a complete breakdown of the patient's ability to accurately represent their subjective experiences. The development of paranoid delusions partially functions to compensate for the patient's inability to make sense of their subjective experiences in relation to an acknowledged other, in this case the psychotherapist. When the patient confronts the psychotherapist with their paranoid delusion and implicates the psychotherapist as a dangerous object, the psychotherapist is potentially exposed to a complex and disturbing dynamic where their own subjectivity may be drawn into question. This paper aims to explore the psychotherapist's experiences of this dynamic in a clinical setting by making use of a composite narrative of a psychotic patient with paranoid delusions that implicate the psychotherapist. The psychotherapist's experiences are discussed via the following three themes: constructing the patient's subjectivity; the psychotherapist's use of their own experiences; and holding the balance between opposing realities.