ABSTRACT
If we were to place our difficult patients into one group and our so-called good patients (more and more difficult to find) into a second group, there is one particular characteristic of most patients in the first group that transcends the individual personality traits that we normally use in making differential diagnoses. Put simply, what our difficult patients most require from us for growth to occur is, paradoxically, the same thing that is most difficult for us to provide-interpersonal engagement that combines affective honesty and safety. Although it is certainly true that this same combination is needed by those in the good-patient group, with that group its provision is part of the natural give-and-take of the relationship and is largely taken for granted as, so to speak, background music.
