In the general hospital (GH), medical staff can find it difficult to establish collaborative relationships with patients exhibiting challenging behavior or personalities. Furthermore many of these patients need complex medical diagnoses and treatments. This paper illustrates an application of the principles of transference-focused psychotherapy (TFP) in a psychiatric consultation for a patient with cardiac disease and poor adherence to medical recommendations. Among the principles of TFP illustrated are technical neutrality and the three channels of communication - verbal communication, nonverbal communication and counter-transference. In addition, the paper shows the use of catamnesis, or the patient's report of their medical history and prior medical treatments. TFP principles allow the psychiatrist to assess the structure of the patient's personality and to help the medical staff to manage their relationship with the patient. TFP principles can be useful tools for psychiatrists working in consultation - liaison services in a general hospital.