Purpose: Pathogenic interpersonal (e.g., intrafamilial) relationships and related patterns are detrimental to the treatment of patients with severe disorders (e.g., psychotic or borderline). A combination of family- and individual-centeredness may facilitate the treatment of these patients in different specialties. The Context-Oriented Model Development in Psychotherapy Planning (COMEPP) represents a diagnostic and therapeutic procedure that integrates systemic and psychoanalytic concepts. METHODS: COMEPP was exemplified with a young man with psychotic PD who had previously failed with medication and psychotherapy. RESULTS: The COMEPP process allowed for adequate treatment after psychodynamic conflicts (e.g., the original projection process from the patient’s mother to her son) were elucidated. CONCLUSION: COMEPP provides a psychotherapeutic approach to patient-specific treatment plans and can be used as a complement to pharmacological and psychological treatment for so-called refractory patients.