The schizophrenic experience is described as an inability to sustain an intentional focus to attention. Attention is captured by incidental details in the schizophrenic patient's environment, and this gives rise to a spurious sense of significance. The patient's inability to direct a train of thought prevents full access to long-term memory so that early components of perception, which are designed to give early warning of threat, are overly influential and unmodulated by further mental processing. These hasty ideas are given delusional conviction when they capture attention and induce a sense of significance similar to the false significance of perception. The schizophrenic patient's lack of control over his mental processes makes him passive in relation to his own thinking. It prevents him from attending to the slight promptings of his subconscious, and when these emotions and intuitions are not amplified by being brought into focus, he loses a sense of himself.

The true self is a central construct of psychotherapy, but its status as fact or fiction is uncertain. Much of the plausibility of the true self comes from the concept's ambiguity, since it encompasses several different kinds of mental entity. It may be construed as a person's belief about himself or herself, as the experience of the working of the mind, or as a characterological essence. The true self is composed of qualities borrowed from these quite disparate kinds of self, none of which, considered singly, readily fits the description. However, if the true self is viewed as a fantasy, grounded on fact, of whom the patient might become, it is an instrument that gives coherence and direction to psychotherapy.

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Patients who can't do what they need to do should be treated differently than those who won't take responsibility for themselves. Mistakenly treating one as the other leads to a confusing sense of failure or may foster regression, and the clinical disagreement between colleagues readily takes on a characteristic moral tone.