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Conventional psychodynamic treatment assumptions sometimes warned against direct confrontation of a patient's delusions because delusions were believed to serve defensive functions. Based in part on research findings some have recently asserted that it can be beneficial for the clinician to challenge a patient's delusional beliefs. Short-term positive results from such confrontations have been reported. I review clinical and research considerations that may aid the clinician in deciding when confrontation may be beneficial. I identify a class of delusions that are unlikely to respond to confrontation. Alternative clinical responses to this class are suggested.

A Clinically Based Rule of Thumb for Classifying Delusions