Some form of individual psychotherapy, in combination with the prescription of antipsychotic medications, is likely the most common treatment for patients with schizophrenia. In the absence of empirical data supporting the efficacy of a particular approach, psychotherapy has often been guided by ideology and deference to authority. In recent years, a reformulation of schizophrenia as a disorder requiring individualized, comprehensive treatment has allowed the development and empirical testing of new targeted and illness-phase-specific individual psychotherapies. This report reviews randomized clinical trials that have evaluated individual psychotherapy of schizophrenia in the context of changing contemporaneous beliefs about the disorder's etiology and treatment. A general approach to individual treatment, termed "flexible psychotherapy," derived from historical approaches but consistent with available clinical and research perspectives, is outlined.