Negative treatment responses in psychiatry.

Powerful disagreements about the helping relationship are often expressed by clinical worsening of the patient and by defensive reactions of the doctor. Typical presenting patterns are the patient who wants "more" from his doctor, or who feels the doctor expects "too much" of him. Resolution of these relationship issues depends on empathic understanding and clarification of the patient's feelings plus small, symbolic, nonverbal gratifications of the patient's felt needs. After resolution of the relationship impasse, specific therapies are more likely to be effective.