Observations of painful affect in the experience of schizophrenia are available in a wide range of writings, including psychoanalytic, biomedical, and quantitative research. To date, though phenomenology has often stressed self-disturbances in terms of perception and thought content, risking neglect of the role of distressing emotional experience in the disorder. As a result, while phenomenology has produced rich accounts of schizophrenia with important implications for treatment, clinical application of these models may lack important attention to emotional distress. To address this, this chapter explores the case of one man diagnosed with schizophrenia, with emphasis on painful affect and its role in treatment. A review of the writings that might inform an integrative conceptualization is reviewed, followed by a discussion of treatment implications in regard to the incorporation of recognition of painful affect in a phenomenologically informed treatment approach.