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Paranoia in the Therapeutic Relationship in Cognitive Behavioural Therapy for Psychosis

Published online by Cambridge University Press:  11 March 2014

Caroline Lawlor
Royal Holloway, University of London, Egham, UK
Katherine Hall
Royal Holloway, University of London, Egham, UK
Lyn Ellett*
Royal Holloway, University of London, Egham, UK
Reprint requests to Lyn Ellett, Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, UK. e-mail:


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.

Research Article
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2014 

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