Structural theory requires us to distinguish between psychoanalytic neutrality (equidistance from id, ego, and superego) and abstinence, a concept that refers to drive gratification. In the process of mastering the frustration engendered by abstinence, the patient develops a mature sense of reality. Competent psychoanalysts continuously assess and regulate the expression of abstinence to promote the emergence and interpretation of the transference neurosis, remembering that they invited their patients to discover and reveal wishes that will be disappointed. These clinicians must unremittingly confront and master their desires and frustrations in order to approach patients with empathy and alliance and to avoid countertransference enactments. The author offers three detailed illustrations of the management of cases that test the clinician's capacity to maintain a psychoanalytic attitude. Two also illustrate the process of cultivating the requisite technical skills in supervision. There is an extensive but focused literature review.