Training and working as a Clinical Psychologist includes engagement with individuals who experience “breaks” from “consensual reality.” This may include: intense, overwhelming affect; perceptual (visual, auditory, tactile) experiences; impulsive behavior that can define or dominate everyday life; and cycles of oscillating, rigid, painful interpersonal and intrapsychic dynamics. This course will examine the range of so-called borderline and psychotic-spectrum clinical presentations using evidence-based, humanistic and psychoanalytic approaches to assessment, conceptualization, and treatment. Coursework will center working empathically with patients in moments of clinical acuity or more chronic struggles, hopefully leading to respectful, collaborative and comprehensive evaluations, risk assessments, and overall decision-making that can enhance psychotherapeutic work.