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Many patients manifest a desire to help the analyst. This is usually understood as being derivative of defensive aims or in the service of other primary motivations. This paper argues for the developmental and clinical importance of primary altruistic aims, which are often warded off by the patient because of his or her fears of exploitation or rejection. Several pathogenic beliefs and varieties of psychopathology result from the failure of the patient's caretakers to allow the child to contribute to their welfare, to “take” the child's “help.” Similarly, some patients require tangible evidence that they are having a positive impact on their analyst. Ordinary “good-enough” technique often reinforces the patient's view that he or she has nothing to offer. A full appreciation by the analyst of the importance to patients of having their altruistic gestures and concerns recognized and accepted can open up possibilities for analytic progress and therapeutic growth. Various sources of resistance to and misunderstanding of these dynamics are explored, ranging from ethical concerns to certain traits that cluster in the personalities of analysts.