The Very Important Patient poses specific challenges to the treating psychiatrist. Whether it is fame, money, power or position that creates the VIP status, this type of patient can elicit similar feelings within the psychiatrist and create various treatment barriers. Boundary violations, accompanying entourage, presentation of gifts, devaluation, scheduling irregularities and transference/countertransference issues are some of the concerns that may arise within the psychiatric treatment of the VIP patient. This article will review the treatment dynamics created by the VIP patient as well as the approaches that the psychiatrist can utilize in a therapeutic manner.