There has been considerable progress in recent years in developing
psychosocial interventions for people who experience persistent psychotic
symptoms. However, it is sometimes difficult to generalise these findings
into routine clinical practice. Long-term, psychodynamically informed,
supportive psychotherapy is a valuable approach for working with individuals
for whom current psychosocial interventions are ineffective or where
unhelpful team reactions are obstacles to care. Its principles are used to
inform a multiaxial formulation, which is shared with the treatment team and
guides treatment, promoting good-quality comprehensive routine care. The
benefits of this approach can best be seen at the individual case level
using a subsequent multiaxial reformulation.