In the last few years the concept of psychiatric psychotherapy has been more widely discussed, due to developments in the professional identity of psychiatrists and a reflection on the place of psychotherapy in psychiatric training. Although this term is long-winded and vague, it is nevertheless concerned with the very foundations of psychiatry. The starting points for this article are a government report about psychotherapy and a discussion of the report by the psychiatric psychotherapy committee of the Netherlands Psychiatric Association. It is argued that psychiatric psychotherapy can only be properly defined if two essential aspects of psychiatry are taken into account: integrative thinking and psychic reality. In its ideal form psychiatric psychotherapy is defined as a type of psychotherapy that a) focuses on syndromes, b) is intended for patients with limited therapeutic goals, c) is based on systems thinking (the biopsychosocial model) and a corresponding theory about psychic reality which centres on the relationship between the patient and his or her mental disorder. The concept of psychiatric psychotherapy can make psychiatrists aware of psychotherapeutic possibilities in the treatment of severe mental disorders.