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Garfield suggests that paranoia be understood in terms of "ego-ideal pathology." The ego-ideal is established in its final form with the resolution of the negative
oedipus complex; traumatic disturbances in this process may lead to idealization of the parent of the same sex. The individual, thus bound to the parent, is especially vulnerable to further "betrayal" by him or her, as the "representative of the ego-ideal." Garfield uses a case to illustrate how such a "betrayal" sets in motion self-critical forces resulting in paranoia. The treatment of the acute state requires, in his view, the utmost sensitivity to the patient's vulnerability to shame, given the superego forces left unbalanced by the loss of the ego-ideal." This means "sharing the responsibility" for treatment interactions, and refraining from challenging the patient's projections (apparently this means those directed at persons other than the therapist) to allow for the gradual idealization of the therapist. Once the acute paranoid state has diminished, the task of analyzing the negative oedipus complex becomes central.