<p>Fear is a central aspect of the experience of psychosis and can take many forms: Fears of psychosis itself, fears of fragmentation, and fears of frightening symptoms such as denigrating voices or persecutory agents. In addition, many people with psychosis are fearful of social rejection due to social stigma. While fear has long been essential to the conceptualization of psychosis and the topic of recent empirical investigation, there has been limited guidance available for therapists who want to help people with psychosis understand and address their fear in psychotherapy. Within the therapeutic context, therapists often experience their own fears of working with psychosis, which may include the worries about harm, experiences of confusion and disorientation that emerge when witnessing psychosis, and the fears of encountering their own inadequacy in the face of clinical challenges. After outlining these common fears that both therapists and patients often experience, four key practice elements are outlined that can reduce fear, including accepting fear and uncertainty in the face of fragmentation, adopting a courageous and vulnerable therapeutic stance, building trust within the therapeutic relationship, and making meaning of fear to enhance emotion regulation. Psychotherapy can be a key intervention to help people with psychosis acknowledge their experiences and learn to make sense of their fear and fragmentation by building a trusting relationship.</p>