A multiphase, qualitative study of ongoing health care relationships from the perspective of the chronically ill patient and family confirmed that such relationships evolve over time through three predictable stages: naïve trust, disenchantment and guarded alliance. In the final stage, four patterns of health care relationships were identified: hero worship, resignation, consumerism and team playing. The configuration of these relationships in guarded alliance is explained by dimensions of the core variable of reconstructed trust--patients' trust in a health care professional and their trust in their own competence.