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Because personal affluence and an alloplastic adjustment tend to go together, psychiatric treatment encounters special problems in trying to help the very rich. These patients frequently show a strong sense of entitlement and a denial of any psychological problem. This creates special treatment problems. They feel entitled to the “very best,” which includes the “best doctor.” If their psychological problems cannot be magically erased they will switch psychiatrists until they find the “right one.” Part of this is a tendency to externalize their emotional problems. Problems are thought to be caused by the environment and not by intrapsychic conflicts. This encourages the therapist to make environmental changes to improve the psychological state. Other special problems that the very rich present include the V.I.P. syndrome, excessive concern with litigation, their excessive narcissism, and their original emotional neglect by their own parents. Many were raised by parent surrogates and have problems in self-esteem. All of these special problems make the very rich difficult to treat with psychodynamically oriented psychotherapy or psychoanalysis. There are some exceptions to this problematic picture in which psychiatric treatment of the very rich can work out very nicely for both patient and psychotherapist.