This refers to a state of mind in which the sufferer has an inaccurate understanding of the nature of his or her relationship to others (either other people in general, or a specific relationship.)

Mostly, the content of paranoid thoughts and beliefs is negative:

"he hates me, he's out to get me..."

Such beliefs and emotional responses may require careful Crisis Contingency Planning to ensure that you are Managing Risk appropriately.

It is important to remember that paranoia can also (less commonly) take the form of falsely 'positive' beliefs about a relationship, such as in paranoid infatuations where a person becomes convinced (against all evidence) that another person loves them. This paranoid condition is known as "erotomania" or "de Clerambeault's syndrome" and may be associated with stalking behaviours. It may be important to recognise this, as it is associated with a heightened risk of Violence (the paranoid person at first is convinced that the other person loves them, but becomes increasingly angry at their "refusal to accept this.")

All of these experiences are a very concrete version of Psychic equivalence - one of the ways that Mentalizing breaks down.

A Mentalizing approach to the paranoid client is helpful - this would lead you NOT to directly challenge or deny the beliefs in a way that could be seen as aggressive, belittling, or shaming - but instead to try gently to "make ones own thinking transparent", ie. to share ones own puzzlement:

"I can understand that you feel very strongly that the police are following you and may even have bugged your room - and that must be a HORRIBLE feeling [here you are acknowledging the mental experience, and empathising with this] and I suppose what I am struggling to understand is WHY the police would want to spend all that money and those resources in doing this - I can't get my head around that, I am afraid. It may be that I am just not understanding things from your perspective yet - can you help me with that?"

At its most severe Paranoia is a symptom of Psychosis and should be taken seriously.