A 43‐year‐old white, single man, who lives with his parents and has been diabetic since the age of 14, has been on center hemodialysis since January, 1990. He worked as an electrician, but because of medical complications connected with his diabetes, he has been permanently disabled since 1986. He failed self‐care dialysis due to major errors in judgment which could potentially have been life‐threatening to him. On center dialysis, he skips treatments on occasion and has interdialytic weight gains averaging 4–8 kg. About once a week he cuts treatment short because of leg cramping and/or arguments with nurses. He demands Xanax while being treated and, if the nurses are reluctant to give him this medication, he cuts the treatment short. On two occasions, he has received emergency dialysis because he skipped three consecutive dialyses.In the past three months the situation has deteriorated further. His weight gains have increased and he cuts dialysis short more frequently. For the past two months, when he comes to dialysis, he takes out a knife and places it on his bedside stand. He has never threatened anyone, but the nurses feel a bit compromised by it.His family has kept themselves very separate from the treatment. He speaks highly of his parents, who, although elderly, are apparently in good health. They are rarely in contact with the dialysis staff. When the social worker has attempted to contact them, they have communicated a lack of interest in being involved with the “problems of the dialysis unit.” Needless to say, the staff finds the patient's behavior and the attitude of his parents a major problem. He is very impulse‐ridden, has little ability to tolerate frustration, and, worst of all, denies any responsibility for his actions or inactions. He complains of an unsatisfactory dialysis schedule and of the nurses being angry with him. He denies suicidal thoughts, but admits to being depressed and f