Long-term psychoanalytic hospitals are seeing increasingly difficult patients, many of whom have been special in one way or another to their previous treaters. These patients present challenging treatment problems. A model of psychoanalytic hospital treatment based on transference-countertransference paradigms as they emerge from the internal object relations of the patient has been presented. This model serves as a conceptual framework with which the treaters can diagnose and clarify the self and object subdivisions of the patient's ego, thereby allowing the patient a greater degree of mastery in a number of spheres of ego functioning.