When I’m teaching psychiatry residents, medical students, or psychotherapy trainees about psychodynamic therapy for psychosis, I frequently hear the same refrain. They very much see the need for the work and want to do it, but are intimidated by the idea that therapy with psychotic people is very different than it is with other patient populations, and that they would have no idea how to begin. What makes a therapy psychodynamic? Three core principles that define a psychodynamic therapy are: Attention to unconscious conflicts and fantasies Fantasies in analytic terms, meaning stories about themselves and others; they can be pleasant or unpleasant fantasies Genetic interpretations Fantasies in analytic terms, meaning stories about themselves and others; they can be pleasant or unpleasant fantasies “Genetic” in analytic terms, meaning regarding early childhood and family relationships Attention to transference Transference being the experience of projecting feelings about important childhood figures onto the therapist Transference being the experience of projecting feelings about important childhood figures onto the therapist In my opinion, dynamic therapy helps people tell themselves a story …