In this paper material is presented from a patient with a diagnosis of a recurrent affective disorder and exhibiting resistance to engaging in the work of therapy alongside the emergence of active suicidal intent. Supervision can help in containing intensely disturbing feelings in the therapist and aid in identifying the underlying psychosis. Through exploration of the counter-transference feelings, the therapist can become attuned to a playing down of the psychosis by the patient and alert other involved professionals. Technically, the challenge remains one of how to make an impact in the sessions through converting a psychotic monologue into a dialogue.