The third challenge is the outcome. Is the patient getting better? In the case of Sara, by all external observations she was getting better. There were fewer periods of suicidality and fewer calls from her mother, and her mother wasn’t sleeping in the hallway anymore. Sara had overcome a particularly paralyzing issue in therapy, and her social circle was extending. In spite of this, Sara could not see any change. So there was a dilemma. Was I deluding myself as to her progress? If not, how could I convey Sara’s progress to her?