The author describes the psychoanalysis of a female patient who was diagnosed psychiatrically as a paranoid psychotic. The patient reported a history of chronic sexual abuse. The psychopathology and the phases of treatment are considered, with particular reference to the dynamics and content of psychotic ideation and their transference and countertransference implications. In particular, the author points to the qualitative distinctiveness of psychotic thought, which, if mistaken for nonpsychotic thought, can generate confusion leading to impasse. Differentiation of the two levels of mentation and interpretation of their symbolic meaning in the nonpsychotic transference is necessary for the psychotherapy of psychosis to proceed.