This classic paper was written by Tom Main in 1957. Main, who worked at the Cassell Hospital in Richmond, South West London, for 30 years, set up a twice-weekly work discussion group after a number of staff began to show signs of stress. Its purpose was to make a retrospective study of those patients whose treatment could be considered a serious failure. What emerged was that each of these individuals had managed to form a “special” relationship with a member of staff. Over time, the group came to recognise how this had happened, and to understand better the evasions and distortions in their team working that had led to this situation developing.