DescriptionMeaning-making research has recently expanded to many fields within clinical and health psychology. However, the concept of meaning making is variably defined across each field and rarely examines the psychodynamic process of symptom construction and construal in those with severe and persistent mental illness (SPMI), particularly psychosis. This paper explores the conceptualization of psychosis through a psychodynamic meaning-making perspective and proposes a related four-stage treatment model. The first stage involves the establishment of safety for the patient in and outside of treatment. Stage two focuses on the attachment processes for the patient, including exploration of experiences of disrupted attachment (if any) and the creation of a holding environment in therapy. In stage three, the patient’s previous and current belief systems are explored, carefully examined, and linked together. The fourth and final stage facilitates the integration of skills learned and used throughout treatment. At termination, the patient now possesses an understanding of the meaning-making process (i.e., how their experiences contributed to the formation of their symptoms and how these symptoms are expressions of the individual’s feelings, conflicts, fears, and wishes) and ways to manage their psychosis going forward.