In this paper I have focused on those aspects of psychoanalytic work with middle-aged and elderly patients that were linked with or arose from reality pressures and intrapsychic conflicts associated with this particular phase of their life cycle, and which they had to face, regardless of their particular psychoneurotic difficulties and character disorders. I have also attempted to illustrate how by an understanding of the nature of transference phenomena in the context of the life cycle pressures of elderly patients, important dynamics, operating in these patients, can become accessible to the psychoanalytic process.