IJSP Number 4, 2022

75 are many instances in which the symptoms of schizophrenia are the expression of terror or defense against terror [4] The psychotherapist must, therefore, help the patient create a world in which she is able to live. The formation of a therapeutic alliance is essential, but, as said before, it is difficult to create an alliance with these patients. The psychotherapist may be perceived as hostile or dangerous, or the patient may believe the therapist conspires against her – often patients do not communicate anything because they do not trust the therapist [12], and the psychotherapist perceives this a failure on her part. 2.2. Difficulties in explaining and reducing the impact of symptoms In the end, an explanation must be found for the patient’s experiences, one that is acceptable for both the patient and the psychotherapist. As a consequence, the psychotherapist must explore the schizophrenic’s history in order to ident ify potential stressors, and the effects of stress are subsequently discussed with the patient. But in the beginning of the therapeutic process, alternative explanations regarding hallucinations cannot be taken into account by the patient [12]. The purpose of psychotherapy is not to forcefully convince the patient that she has signs of a mental illness. The purpose is more in the line of diminishing the severity of symptoms and associated stress. In order to work with the delusions, we will begin with “peripheral questions”: questions regarding the patient’s belief system, in order to understand the way the patient reached certain conclusions. Peripheral questions are connected to gradual reality testing, which may lead to doubts and generating alternate hypotheses [13]. In order to generate efficient coping strategies the psychotherapist seeks to identify situations in which the hallucinated voices intensify. The emotional response to the voice hallucination (usually anger and anxiety) is often related to the behaviors they maintain, which in turn exacerbate the voices. Once the pattern is identified, the patient is guided towards having a constructive relationship with the voices [12]. But for the psychotic patient, psychotic symptoms become one with the self, so accepting she has a mental disorder is difficult for the patient. On the other hand, the patient will generate an explanatory model for the changes she goes through, because of the need to explain what happened. Most patients do not attribute these changes to a mental disorder before they are diagnosed. The explanation is probably possessing and introjecting significant influences, as a reaction to trauma. If introjects are accepted and become identified as parts of the self, then auditory hallucinations may be the consequence of the fragmented ego parts [12]. One of the “temptations” for the psychotherapist is to seek alternative explanations for delusions and hallucinations right from the first psychotherapy session, hurrying in that direction, as if she cannot tolerate this alternate world the schizophrenic creates in her mind. Work with the schizophrenic patient exposes the psychotherapist to intense distress and a very odd behavior, which is often confusing, leading to extreme feelings for the therapist. Schizophrenia scares the clinician and cannot be observed in a detached manner, so it triggers countertransferential reactions. The patient’s psychosis seems to resonate with the