Because they have little parental contact, many children of the very rich lack self-esteem and clear role models, resulting in shallow values and pathological narcissism. Low self-awareness and the absence of great suffering work against therapeutic progress, as do the efforts of the parents, who may feel threatened, and countertransference feelings of envy or anger by middle-class therapists. A supportive psychotherapeutic relationship is the most likely means of developing trust and self-discipline in these patients.