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The authors' experience includes therapy with some one hundred outpatients whose mean age was twenty-four. Twenty-five per cent of these were women, twenty per cent black, and all were on methadone maintenance and opposed to therapy. Relevant here is the consideration of whether coercion to accept therapy is not a violation of civil rights. Almost inevitably the reluctant patient develops a regressive and hostile dependency while the therapist experiences, consciously or not, an arbitrary and patronizing attitude. These authors countered such difficulties by using gentle pressure on the patients to encourage them gradually to assume increased responsibility and control of their lives. The nonparticipant patients were allowed to remain silent. The therapist worked to maintain and enhance self-esteem, while helping the patients to face their painful affects and to understand the denial and projection with which they usually dealt with such affects, rather than demanding surrender of their defenses. The patients' problems, conscious and unconscious, their resistance to treatment, and technical considerations are explored in detail.