The relationship that is established between the nurse and the patient is the result of interplay or covert negotiations until a mutually satisfying relationship is reached. Depending on the duration of the contact between the nurse and the patient, the needs of the patient, the commitment of the nurse and the patient's willingness to trust the nurse, one of four types of mutual relationship will emerge: a clinical relationship, a therapeutic relationship, a connected relationship or an over-involved relationship. If the nurse is unwilling or unable to be committed to the patient, a unilateral relationship will develop, with the patient continuing to use manipulative or coercive behaviours, attempting to increase the nursing involvement in the relationship. If the patient is unwilling to trust the nurse and accept his or her illness situation, she or he will manifest ‘difficult’ behaviours, be withdrawn or elope. The changing nature of the relationship, and the conditions and consequences of each type of relationship are discussed.