Paranoia in the therapeutic relationship in cognitive behavioural therapy for psychosis.

BACKGROUND AND AIMS This study explored therapists' and clients' experiences of paranoia about the therapist in cognitive behaviour therapy. METHOD Ten therapists and eight clients engaged in cognitive behaviour therapy for psychosis were interviewed using a semi-structured interview. Data were analyzed using thematic analysis. RESULTS Clients reported experiencing paranoia about their therapist, both within and between therapy sessions. Therapists' accounts highlighted a number of dilemmas that can arise in responding to clients' paranoia about them. CONCLUSIONS The findings highlight helpful ways of working with clients when they become paranoid about their therapist, and emphasize the importance of developing a therapeutic relationship that is radically collaborative, supporting a person-based approach to distressing psychotic experience.