Sarah has always had a problem with her peers from childhood to the present. She has never had a friend in whom she felt she could confide because she suspects the motives of everyone. When any remark is made as a joke, she takes it personally and has a tendency to carry a grudge. Sarah feels that she is the constant butt of attacks on her reputation and this has caused a great deal of difficulty in any on-going relationship she has had with a man. She is always questioning their fidelity without grounds to do so. It has resulted in most of the relationships breaking up rather quickly and Sarah feels she's been cheated by life. There is no history of psychotic illness, no mood disorder, no familial history of psychosis, or serious medical illness and Sarah is in good physical health for her age. A middle-aged woman comes to your office after missing her first appointment. When she rescheduled she said that she was not able to get to your office because she had no friends to ask for a ride. Today her daughter was able to drive her. She is dressed in a very colorful outfit with a very large hat that is pink with long ears. She says she really does not like going out in public, but when she does, this hat protects her from other people. A 40-year-old male comes to see you at the insistence of his wife. He states that there is nothing wrong with him, but if seeing a psychiatrist will shut his wife up, then he is willing to do it. The client is a very successful businessman. He tells you that his wife recommended he see a therapist, but he stated that if he was going to receive counseling then he wanted to see a psychiatrist because they have more education. The patient states that his wife is frustrated because they have no friends, and that the client is too picky about people. Upon further elaboration the client says that he is not going to spend time with just anyone, and that spending time with people less educated and intelligent then himself was a waste of time. When asked about his job, the client states that it is okay, but he is under appreciated. He says that without him the company would never make any money, but that nobody ever recognizes how important he is to the company. Joanne is a 35-year old single female, who is very concerned that she will be abandoned by her boyfriend. She has always been very intense in her relationships, many times alternating between idealization and devaluation, often is highly impulsive, and engages in reckless driving and casual sex. When left alone, her thoughts turn to suicide and she has made several gestures in the past. Her mood ranges from intense dysphoria to anger and she sometimes suffers from feelings of dissociation.