Schizophrenia, in conjunction with obsessive-compulsive symptoms, presents significant barriers to treatment. This is true even if the obsessive-compulsive symptoms would ordinarily be considered straightforward for cognitive-behavioral treatment. These many limitations in treatment are considered here in light of the information processing deficits that are associated with schizophrenia. Further, the demands of exposure with response prevention, used in the case of Sam, require special considerations in complex cases such as these. We highlight some of the specific approaches necessary in the clinical care of schizophrenia with obsessive-compulsive symptoms in light of the information-processing deficits associated with each problem, and discuss some of the issues faced in clinical settings where there is a reliance on empirically supported treatments for conditions or classes of symptoms. The specific considerations raised here extend to cases of obsessive-compulsive disorder (OCD) that are complicated by the presence of overvalued ideas, essentially a delusional subtype of the disorder.