It was getting near the end of our fifth counseling session and I still hadn't made any headway against his delusions. This was definitely one of my more difficult cases. Every time I thought we were finally getting somewhere he would dig in his heels and I'd run smack into the brick wall of his denial. I sighed, and started again, “Look, we all have feelings, a sense of who we are in the world. But simply feeling like you are something doesn't make you that...”

“You HATE me!” he yelled, glaring at me with wounded resentful eyes, “Why do you hate me so much?”

This had come out of nowhere, but I was getting used to these sudden random accusations by now. By forcing me to defend myself he was shifting the focus away from him and the state of his mental health. I said calmly, “I don't hate you. I wouldn't have come here if I hated you. I care about you like I care about all my patients-”

“LIAR! If you cared you wouldn't be attacking me for just trying to live my life as who I am!”

“I'm not attacking you. I'm just trying to get you to see reality.”

“That's your reality, not mine! And it's not even real, not really! I know who I am!”

“Are you sure about that? Just because you claim to 'identify' as something, it doesn't make it the truth. I might identify as a giraffe or a superhero or the King of Siam; but truth is I'm just a man, and so are you.”

“Bullshit! I know who I am, and all my friends know too. They support me in my transition!”

“I'm afraid your little circle of friends is as deluded as you are; living in this shared fantasy that's completely removed from the facts,” I said, “Although I think some of them are just be humoring you; they know how overly emotional you tend to get, especially when you feel cornered; and that you can be incredibly vindictive when things don't go your way. Like bringing a nuke to a pillow fight!”

“I don't just feel cornered, I AM cornered! Everyone's attacking me! They're all horrible nasty people like you, and like those mean thirteen year old girls on Tik-Tok who keep cyberbullying me! You all hate me because you're jealous of me and just want to tear me down!”

“It might seem that way. But other people have needs and wants too. You've got yourself barricaded in this big house, but it doesn't belong to you now. The new tenants need to move in here so our country can move forward. It isn't fair for you to cling to something that isn't yours anymore-”

“LIAR!!” roared Donald Trump, and started stamping his feet in a petulant frenzy as he shrieked, “YOU'RE JUST A LIAR AND A BULLY; YOU LOW INTELLIGENCE LOSER! THE DEMOCRAPS AND THE FAKE PHONY NEWS MEDIA AND THE DEEP STATE AND ALL THOSE FAKE-REPUBLICAN TRAITORS AND THE VOTING DEAD PEOPLE AND THAT EVIL C.I.A. VOTE CHANGING COMPUTER AND THOSE STUPID JUDGES WITH THEIR STUPID DEMANDING PROOF, THEY'RE ALL SUFFERING FROM TRUMP DERANGEMENT SYNDROME AND THEY STOLE THIS ELECTION FROM ME; AND YOU'RE IN ON IT WITH THEM, TRYIN' TO TRICK ME AND FOOL ME INTO GIVING UP WHAT'S MINE! BUT YOU CAN'T GASLIGHT ME, I KNOW WHO I AM!! I'M A STABLE GENIUS AND THE GREATEST LEADER IN THE WHOLE HISTORY OF THE UNIVERSE, EVER!! AND I'M GONNA MAKE MY SMOOTH TRANSITION TO MY SECOND TERM IN OFFICE AND GO ON TO GREATER AND GREATER GREATNESS UNTIL I'VE MADE AMERICA ALMOST AS GREAT AS I AM!! AND NOT YOU OR ANYBODY CAN STOP ME!! I'M STILL THE PRESIDENT, I'LL ALWAYS BE PRESIDENT!!! I WON!! I WON!! I WON!! I WON!! I WON!!!”