Why do some psychiatric patients fail to get better, even when in the care of competent clinicians? This clinical guide begins where standard textbooks end, focusing on clinical strategies to be used after all basic treatment options, such as medication and psychotherapy, have failed. Expert contributors address the sequential clinical steps to be taken in treating difficult-to-treat psychiatric patients by offering a blend of evidence-based recommendations, detailed case vignettes, treatment algorithms, and - when necessary to go beyond the reach of evidence - the clinical wisdom of leaders in the field. The chapters of the work are organized by major disorder (schizophrenia, depression, bipolar, anxiety, posttraumatic stress, borderline personality, dissociative, eating, and substance abuse disorders; traumatic brain injury; and comorbid medical illness). Each chapter offers concrete recommendations on what to do when the usual first steps in therapy are ineffective, including evidence for biopsychosocial treatments alone versus in combination, generic versus specific therapies, and literature reviews and expert wisdom.