In his work, the analyst may notice that his subjective sense of effort varies widely from patient to patient. Study of the treatment process in the case of 'hard' patients reveals that in them there always exists some lack of congruence between the analyst's goals for the treatment and those of the patient. When the analyst experiences a feeling of 'trying hard', an unconscious sense of guilt and unconscious anger are apt to be present in relation to that patient.

Particular types of patients are especially likely to provoke this experience. With certain obsessives the analyst may feel burdened because he identifies with the patient's laboured way of living. With schizoid characters the analyst may be working hard because he is always courting the patient, trying to get him involved. In the case of depressives the analyst may be 'trying hard' because he is attempting to meet the patient's demands for reparations.