The patient, along with other boys, was sent into an institution that was in theory designed to provide protection against the violence and disruption each had already experienced. In the institution, however, they were subjected in the name of "treatment" to prolonged severe sexual abuse and threatened with further rejection, loss, or violence if they did not comply. Such abuse by persons in authority who bore the symbols of help and protection led to a chronic inability to trust other people, particularly those in any position of authority. This mistrust is often demonstrated by the patient's chronic untrustworthiness. This reversal obliges the "other" to be the one who is disappointed, abandoned, let down, hurt, and betrayed; thus, the patient puts those who interact with him in a state of apprehensiveness. Broken appointments, promises, and unmet debts may be frequent. Alcohol or other addictive substances may seem to be more reliable and controllable than another person. It is crucial that those who treat such patients be prepared to sustain support and confidence for the patient in the face of repeated rejection and untrustworthiness by the patient. The psychotherapist must interpret to the patient what is happening between them so the patient may gain the cognitive and emotional perspective necessary for behavioral change.