Countertransference issues for the consultant when a colleague is critically ill (or dying)

This report illustrates how countertransference issues emerged for a consultant therapist whose guidance about practice was sought by an ill and dying colleague. The detechment necessary for consultation was difficult to maintain. Denial, avoidance, and isolation operated for both. Ambivalence about directive behavior developed. Unexpressed grief, shock, feelings of inadequacy, and identification with the colleague intruted but were managed. The occurrence of such countertransference phenomena can be anticipated and understood in a consultation process that represents one valuable, underutilized, and important means of encouraging quality clinical practice under extremely painful circumstances.