The author delineates various patterns of psychopathology and impaired relationship capacities in persons referred to the Professionals in Crisis program, patterns that are often associated with failure to respond to prior treatment. He articulates a model of treatment that entails a synergy among three domains of intervention: enhancing mentalizing, strengthening impulse control, and promoting awareness of others' mental states. He addresses the challenges this approach poses for both patients and staff members as they develop attachment relationships that foster mentalizing.