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Searles discusses the tendency to present Dr. Pearson as the "good mother" and Dr. Z as the "bad mother." He points out the advantages of working with such a patient in the contained atmosphere of an inpatient unit, and the difficulties inherent in the outpatient setting. Even if the previous therapist has been scrupulous in breaking off contact, the patient may feel abandoned. Searles, believing countertransference responses to a patient like Mrs. X to be inevitable, points out how Dr. Pearson lets herself be drawn into behaviors similar to those she condemns in Dr. Z. He speculates that the fear this will happen causes Dr. Pearson to avoid the transference relationship with Mrs. X early on, and thus to allow the relationship with Dr. Z to continue. Negative transference was displaced or acted out with the ward nursing staff, Dr. Pearson's supervisors, and in the patient's artwork. After tracing the oedipal themes in the transference, Searles turns to his and Melanie Klein's work on early ego development and the differentiation between the human self and the surrounding nonhuman environment. He uses these concepts to explicate the relationship between Mrs. X and the hospital itself. Returning to the countertransference, he sees the use of medication during the termination of hospitalization as the inability of the therapist to tolerate the attendant sadness, murderous rage, envy, and relief.