Book excerpt: More than ever, the aging process is recognized as carrying a special set of emotional challenges–especially when acute or chronic medical conditions are involved. In this light, Psychodynamic Perspectives on Aging and Illness presents a fresh, contemporary application of psychodynamic theory, addressing the complex issues surrounding declining health. Informed by the spectrum of psychodynamic thought from self, relational, and classical theories, this forward looking volume offers more modern interpretations of theory, and techniques for working with a growing, complicated, but surprisingly resilient population. It illuminates how to enhance the therapeutic relationship in key areas such as addressing body- and self-image issues, approach sensitive topics, and understand the disconnect that can occur between medical patients and the often impersonal, technology-driven health care system. At the same time, the author cogently argues for pluralism in a therapeutic approach that is frequently threatened by forces both within and outside the field. Among the topics covered: Medical illness as trauma. Idealization and the culture of medicine. Normative and pathological narcissism in the ill and/or aging patient. Noncompliant and self-destructive behaviors. Transference and countertransference issues. Psychotherapy with cognitively impaired adults. Grief, loss, and hope. Expanding on what we know and candid about what we don’t, Psychodynamic Perspectives on Aging and Illness offers mental health researchers and practitioners an insightful framework for improving the lives of older patients.