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When treating a patient presenting a first psychotic episode, clinicians face many challenges. Among them, two main challenges emerge in almost every case: denial of the illness, and disengagement from treatment. These two elements may have major consequences, considering that psychosis usually emerges at the end of adolescence or at the beginning of adulthood, a phase of life during which many of the broad outlines of one’s existential trajectory are defined. In this paper we discuss the various strategies developed in the Treatment and Early Intervention in Psychotic Disorders Program (TIPP) in Lausanne to overcome these obstacles and to facilitate engagement and the development of insight. This last point is a very delicate aspect of treatment, during which the objective is to help the patient to build a new social identity that integrates the psychotic episode in a constructive manner, while avoiding the emergence of a self-stigmatization that would have a negative impact on the recovery process. As such, the development of insight is a therapeutic process rather than an aim in itself.