Working with severely disturbed patients is one of the most challenging and difficult areas for the psychotherapist in private practice. Not only is there an ever present risk of a psychotic episode but, worse, the patient may threaten or actually commit suicide. The following gives an account of one such patient. Describing the typical ambience of the sessions, it tracks the developing realization for the therapist of the patient's involvement with the psychiatric system, and the consequent ethical dilemmas, which remained unresolved. Finally, it considers from the therapist's point of view what factors may have led to the patient's suicide.