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In this paper, the author describes aspects of his work as a psychoanalytical psychotherapist in a hospital for diseases of the colon and rectum. After reviewing some of the earlier psychoanalytic literature (Freud and Abraham), and more recent theoretical contributions, two cases are described in some detail, which help give a flavour to some of the work. The paper concludes with caveats about the internal and external working environment, which will facilitate or hinder working in particular medical settings.