Hospitalized patients with treatment resistant comorbid Axis I and II psychiatric disorders have in common a developmental history that includes a lack of fit between their needs and their human environment. Adaptation of their personalities to this environmental failure contributes to these patients' lack of trust in authority. Treatment resistance may represent a repetition of this early experience, with the current biological and symptom focus of the field representing yet another insufficient environment. The author describes the components of a psychodynamic treatment institution that focuses on overcoming this dilemma through studying the process of relationships, attending to meaning, and maximizing patient authority. These principles may be applicable in a range of treatment settings where clinical staff members work with so-called “treatment resistant” patients.