This chapter addresses the unique clinical challenges of psychosis occurring within personality disorders, highlighting how maladaptive interpersonal patterns, emotional dysregulation, and chronic schema disturbances influence psychotic symptoms. It emphasizes the need to differentiate trait-based vulnerabilities from state-related psychotic features to avoid misattribution and mistreatment. Treatment planning must account for issues such as mistrust, affective instability, impulsivity, and relational conflict, which may complicate alliance-building and technique delivery. The chapter provides a framework for adapting CBT modules—prioritizing stabilization, emotional regulation, and schema-focused strategies—before applying standard CBT techniques for psychosis. This ensures therapeutic safety and improves engagement in complex personality-psychosis presentations.