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The author suggests that in selected manic and hypomanic patients the content of their expressed thoughts can be used, during the acute phase of illness, to initiate insight-oriented psychotherapy. The aims of this therapy include (1) detection and analysis of important psychological themes revealed by the patient during the acute manic phase, and (2) interpretation and working through of the manic defenses. Three case reports are presented to illustrate the author's contention. The patients had well-integrated premorbid personalities and high ambitions and ego ideals, both of which served to undo early trauma. The manic defenses were an attempt to preserve these ego qualities and the positive inner objects they represented. Mester discusses countertransference problems and resistances in the therapist to psychotherapy with manic patients. These include (1) loss of confidence, decrease in self-esteem, and devaluation of the therapist by a manic patient; (2) fragmentation anxiety due to identification with the patient's inner turmoil; (3) overstimulation by the patient's aggression and hyperactivity; and (4) anxiety over the threat of losing control of instinctual drives due to identification with the patient.