Th ese clients appeared to cling to behaviors, defenses, and cognitive distortions that were useful in their past but were not adaptive to their present situation. Th ey had poor skills for managing aff ects and behaviors and had defi cits in self-concept, empathy, trust, communication, and academic performance. Th ese were unhappy clients creating further unhappiness for themselves and others. Th ey had problems that manifested in their relationships and initially in the therapeutic relationship as a transference test. Rather than provide healing, their daily relationships reinforced their defenses and negative expectations. Th eir pathological approach to others was a major focus in their treatment, especially when it interfered with forming and maintaining the therapeutic relationship and surfaced in peer and family interactions.