Schizophrenia is a chronic terror syndrome. Patients who develop psychotic symptoms have had lives that would drive anyone crazy. It is necessary to create a therapeutic alliance by offering real help with what the patient perceives as the problem. Severely disturbed patients need a warm, strong therapist who will deal with anything. The sicker the patient, the more structure and support the therapist must provide.
Conscious insight is helpful, but it is only bearable within a strong, safe relationship.
Hallucinations are understood and interpreted like dreams. The patient uses the therapist for corrective identifications. The therapist is internalized as a less destructive superego, replacing the punitive conscience that is based on the parents. The therapist also provides a model for the ego, how one might be. The relationship with the therapist is internalized as what a human relationship might be like.