Psychotherapy with older dying patients can lead to problems of countertransference for the clinician. Working with dying patients requires flexibility to adapt basic therapeutics to the institutional setting. Goals of psychotherapy must be reconceptualized for dying clients. The problems of countertransference arise because clinicians themselves are not prepared for death. In therapy the clinician too is caught up in waiting for the death of the client. The sights and smells of terminal illness may be repulsive to the clinician. Therapy with dying clients and their families must be time flexible; therapists are needed at irregular times. Therapists should assist clients in the productive use of defense mechanisms in the dying process. A therapeutic relationship is best established as soon as the client knows he or she is dying. The therapist can help clients to determine the best use of remaining life and aid them in reviewing their life constructively. Dying people need to retain as much control of their lives as possible, especially in the face of medical intervention and pain. As the client becomes more isolated from people, therapists can provide needed support. The therapist should remember that clients have little energy for emotional therapy. Finally, all dying people are not in need of therapy; many already have their own personal philosophies which help them cope with death. (ABL)