ABSTRACT
Ironically, the concepts of psychoanalytic psychotherapies become increasingly relevant as talk fades and fundamental psychological issues become all-encompassing. Attachment insecurities, regressive transferences and staff countertransferences, the temptation of professional boundaries to be eroded, the fears of dying, and the loss of autonomy are issues eased by an understanding of psychoanalysis. The psychological massaging of hope is a core task of palliative care, but this does not necessarily mean strengthening the hope. Reframing hope may eventually result in surrendering hope. Mature ego defences, good psychological health and ‘mature hope’ tend to be cited as prerequisites for being able to contemplate the ‘depth work’ necessary to address that death may be the absolute end of existence. Demoralisation is a psychological conceptualisation of hopelessness. The retrenchment to ‘primary narcissism’ has consequences. Increased sensitivity and reactivity to emotional events is balanced by the psychological soothing provided by carers.
