This paper is concerned with the dynamics and management of ambulatory patients in states of deep distress and tension, with anxiety and agitation. Their working capacity and ability to adapt to everyday life is threatened. The patient faces an insoluble dilemma: 'Without mortal danger there will be no help, but the conviction of mortal danger creates intense anxiety'. Mittelmann analyzes the transference reactions in such situations, and suggests flexibility in the analytic technique: active sympathetic reassurance, sitting rather than lying during treatment, and other devices to allay the acute anxiety.