The authors describe the interactions between and the differential effects of carbamazepine and individual psychotherapy in the treatment of a schizoaffective patient. Carbamazepine's impact on the patient's affective life facilitated the establishment of a working alliance in psychotherapy. As the patient began to understand and differentiate aspects of his affective, cognitive, bodily, and interpersonal experiences, his life situation stabilized and his carbamazepine dose requirements diminished.