Many patients in long term care institutions have inordinate emotional needs which the staff's provision of standard trealment, comfort and personal hygiene cannot meet. This clash between their compelling needs and the staff's reasonable responses produces the irascible patient who is fmstrating and discouraging to even the most committed caregivers. To understand and treat these patients' problems, common developmental histories were examined and treatment undertaken that went beyond the supportive endeavors usually considered all that can be done for this patient population. To help these individuals recover a sense of their lost competence and identity, the social worker reviewed their work experiences with them and elicited the capabilities they used when they lived independently. Although this process did not make them compliant, contented patients, useful memories were revived and dimmed identities rediscovered. They were able to develop more trust in their caregivers and set more reasonable expectations for theif care. While the emphasis of this article is on these interventions, they are presented as an additional treatment effort, not as a substitute for evaluating and improving how caregiving staff is trained and supported so that they can interact more effectively and humanely with emotionally difficult and needy residents.