Part I: Case Conceptualization. Needleman, Case Conceptualization in Preventing and Responding to Therapeutic Difficulties. Freeman, McCloskey, Impediments to Effective Psychotherapy. Tompkins, Effective Homework. Part II: Metacognition and Emotion. Wells, Anxiety Disorders, Metacognition, and Change. Leahy, Emotional Schemas and Resistance. Holland, Avoidance of Emotion as an Obstacle to Progress.Part III: Specific Populations. Haddock, Siddle, Psychosis. Newman, Bipolar Disorder. Smucker, Grunert, Weis, Posttraumatic Stress Disorder: A New Algorithm Treatment Model. Schaffer, Binge-eating and Other Eating Disorders. Part IV: Couples and Families. Epstein, Baucom, Couple Therapy. Dattilio, Family Therapy. Part V: Psychotherapy Processes. Foertsch, Manning, Dimeff, Difficult-to-Treat Patients: The Approach from Dialectical Behavior Therapy. Stevens, Safran,Muran, Obstacles or Opportunities? A Relational Approach to Negotiating Alliance Ruptures. Tafrate,Kassinove, Angry Patients: Strategies for the Beginning Phase of Treatment. Marcinko, Medication Compliance with Difficult Patients. Leahy, Conclusions.