The psychodynamics of working with psychosis: why the countertransference should be part of the mental state examination

SUMMARY This commentary emphasises key ideas in psychodynamic approaches to psychosis, as described in an article in this journal by Rachel Gibbons. Drawing on the case made for an understanding of the psychological processes that underlie psychotic symptoms and how these affect clinical staff, this commentary reinforces the need for a ‘mind-based’ approach to understanding psychosis. The powerful impact of unconscious processes as an ordinary part of human communication is described and the argument made that attending to the countertransference is a key clinical tool in psychiatry, and should be considered a routine part of the mental state examination.