This paper considers the difficulties encountered by nursing staff in managing a spinal cord injured patient who refused to comply with treatment protocols and who verbally and physically abused both himself and members of staff. The patient, Ben, had fallen 30 feet, sustaining a fractured sixth cervical vertebra and a head injury, becoming quadriplegic. Written as a case study, the paper includes substantial reflective analysis. It attempts to establish a framework which minimizes both client and staff stress while achieving mutually agreed treatment goals based on concepts of clinical supervision for staff and the autonomy of patients.