Older adults exhibit psychotic symptoms for various reasons. Treatment may require medical and psychiatric intervention, family support, community services, etc. The role of psychotherapy, however, has received little attention. This article describes a psychotherapeutic approach to treating older adults with psychotic symptoms based on the literature and the authors’ own experience. The approach includes reaching out to identify individuals in need of help; clinical engagement to develop a working relationship; linkage with needed services; and helping individuals reduce the link between triggers and psychotic symptoms. Differences between treating a person with delusional disorder versus schizophrenia are discussed.