The author notes a parallel between his heightened capacity to experience pleasure in life after discovering that he has metastatic cancer and the surprising mobilisation of therapeutic forces displayed by his patients after sharing with them the news of his illness. He presents four clinical vignettes and compares and contrasts his findings with those reported in the relatively sparse and inconclusive literature which emphasises the negative aspects of dealing with this kind of threatening reality. The author notes the usefulness of sharing external realities with his patients, which then functions in dialectical interplay with a classical focus on unconscious fantasy, both in extreme and ordinary therapeutic circumstances. This extends and elaborates on the author's previously reported work on ‘comprehensive countertransference’ being a ‘real person’ and therapeutic action.