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Epstein proposes that a home care nurse may be a valuable assistant in the treatment of certain markedly dysfunctional patients for whom intensive psychotherapy alone does not provide sufficient protection from serious acting out, but for whom hospitalization tends to thwart their capacity for adult ego functioning and for separation from sources of realistic self-esteem, or to threaten regression. Such patients may also have formed a pathological adjustment within the family, and this may provide a resistance to progress in psychotherapy. They often cannot acknowledge their therapeutic dependence on the psychiatrist, or accept appropriate care from a family member, since recognition of their reliance on other persons evokes overwhelming rage, often focused on the imperfections of these individuals as caretakers. A professional nurse in the home allows the patient to form a relational bridge between family members and the psychotherapist. Detailed presentations of patients with borderline personality disorder, psychogenic pain disorder, and postpartum depression illustrate the technique. The author also presents guidelines for implementing this treatment and for collaborating with the home care nurse.