The framework depicted in Figure 1 has served as a helpful reference during this discussion. Focusing on the contribution of role-expectations to students’ emotional responses, the framework schematizes students’ views of their patients’ and their own roles and responsibilities in the therapeutic relationship. The vertical axis represents the patient’s agency with regard to his or her psychiatric illness. At one end, illustrated at the top of the axis, students view patients as fully accountable for their symptoms. At the other end, students view patients as subject to, or eclipsed by, their illnesses, and not held responsible (6). The horizontal axis represents students’ views of their roles, ranging from, at one end, “owning” patients’ problems and bearing responsibility for fixing them, to, at the other end, allocating responsibility to the patient and supporting patients’ struggles (7). Students in the “ownership” position are vulnerable to rescue fantasies, where, in the extreme supportive position, students may feel impotent and unfulfilled. Although represented graphically as continua, the dimensions depicted on the vertical and horizontal axes may be more helpfully viewed as dialectics, or opposing principles, challenging students to embrace both poles simultaneously. Although the framework’s concepts are familiar to doctors, particularly psychiatrists, they may be more novel for medical students just beginning to assume clinical responsibility.