NICE (2004) notes that some patients are treatment resistant. This is defined as not having responded to adequate trials of two or more anti-depressants at an ade- quate dose for an adequate time. - [[Book - Psychotherapy and Counselling for Depression 3rd Ed]] It could be resistant to medication and psychological therapies as well. **It could mean patients take longer to develop trusting relationships or feel low shame enough to begin the change process**. - *But there is also resistance to psychological therapies. In regard to the latter, resistance may relate to the degree of how embedded and trapped people are in unsupportive or critical environments or the length of time it takes for some patients to develop a trusting therapeutic relationship, and feel sufficiently low-shame to begin to engage in the process of change.* - [[Book - Psychotherapy and Counselling for Depression 3rd Ed]] page 12-13