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As in all forms of psychotherapy, the patient–therapist (student–teacher) relationship must be maintained on a positive level. In the event of a patient–therapist misalliance the rupture or misunderstanding must be repaired. A positive learning experience takes place in a supportive relationship in which the patient can be challenged and results in enhanced learning (Caine and Caine 1994). Patients need to understand that learning may involve taking risks by embracing uncertainty and change, which often requires that the therapist be reassuring and helpful. Patients should be involved in mutual planning with the therapist in setting relevant goals and objectives in a collaborative manner (Knowles et al. 1998). When patients participate in determining their goals and objectives, motivation will be enhanced, and they will have more control over their learning. On the other hand, a threatening environment may inhibit learning.

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