The case of Helen D.: a woman who learned to suffer.

Despite our earnest wish to be useful to patients, we sometimes fail. Part of the difficulty often has to do with the expectations that the patient brings to therapy. Another contribution to an impasse may be the psychiatrist's theoretical orientation. This review illustrates a playful distortion of the doctor-patient relationship so as to develop an alliance with a difficult patient. The involvement of part of her family in the long-term treatment facilitated her growth out of a biopsychosocial swamp.