The aim of psychiatric treatment at Riggs is to help an individual take charge of his or her life. Facing the limits of reality and managing within those limits are important ways to take charge. A significant reality that requires focused attention is the limit of financial resources for treatment. We routinely include patients and their families (if they are paying for treatment) in discussions about the cost prior to admission and during treatment. Patients are encouraged to work with their treatment team to design the most cost-effective course of treatment that meets their clinical needs within the resources available. We have learned that the limitation of financial resources is both a reality and a powerful metaphor for other limitations in life. Attention to the practical and emotional consequences of these limitations is often a useful focus for treatment.