Not a victim: How self-deception saved David.

This paper summarizes a course of psychotherapy in which the therapist integrated concepts and strategies from psychoanalytic and cognitive-behavioral orientations in treating a gay man with HIV-associated neurocognitive disorder and a history of sexual abuse. The article highlights the psychologically protective function that deception served in the treatment of this patient, and how the therapist navigated the fragility of these inner fictions. Further, it illustrates the way in which the therapist-patient dynamic was colored by a psychoanalytic process known as projective identification.