This chapter will move beyond the dynamics of personality development to consider some essential aspects of the therapeutic relationship.  In particular, the transference relationships between patient and therapist and how they are critical to clinical work in all fields of medicine and form the core of psychotherapeutic activities will be discussed.

The adolescent lives with a vibrant sensitivity that carries to ecstatic heights and lowers to almost untenable depths. For some, the emotional stability achieved in childhood and the security of the family attachments contain the amplitude of the oscillations and permit a fairly steady direction; whereas others must struggle to retain a sense of unity and a modicum of ego control.

The lengthy developmental process as a dependent apprentice in living draws to a close as individuals attain an identity and the ability to live intimately with a member of the opposite sex, and contemplate forming families of their own. They have attained adult status with the completion of physical maturation, and, it is hoped, they have become sufficiently well integrated and emotionally mature to utilize the opportunities and accept the responsibilities that accompany it.

Occupation and personality traits are intimately related.

Along with the hazards and the need for realignment of personality functioning, the marriage brings with it new opportunities for self-fulfillment and completion.

The topic of marital adjustment involves the requisite shifts within each person—within the personality of each—that make possible the necessary interrelationship that proximates a coalition; it concerns the finding of reciprocally interrelating roles that permit the meshing of activities with minimal friction; it includes the reorganization of the family patterns which each spouse learned at home, and which may involve differing ethnic and social class patterns, into a workable social system; it concerns how the childhood family romance of each partner can find consummation.

The birth of a child, perhaps actually the awareness of conception, changes the marital partnership by the need to make room—emotional room—for a third person. The product of their unity can be a strong bond, a source of common interest and shared identification, but children are also a divisive influence—in varying proportions in each marriage, a unifying and separating force. In becoming parents, the marital partners enter into a new developmental phase.

The middle years start when persons achieve maturity, usually in their early thirties, having gained the skills, knowledge, and assurance needed to settle into their careers and family lives. They are caught up in the challenge of making the most of their abilities and opportunities. They soon move into the period most people consider the “prime of life,” the years between thirty-five and fifty-five, during which they reach the midlife transition or crisis—a period of stocktaking, and perhaps of reorientation, occurring around the age of forty—and become middle aged. Middle age is usually a period of fruition, but often a time of coming to terms with where one’s life is going. Then, as persons enter their mid-fifties, the efforts and creative capacities of most, though far from all, persons diminish as they tend to coast on previously gained skills and accomplishments until they reach old age, which is rather arbitrarily considered to start at about sixty-five.

People have changed over the past several decades and now increasingly welcome retirement as an opportunity to live in leisure, and they accept and anticipate retirement as part of their life cycle. Whether retirement can be enjoyable—an autumn of deep but brilliant hues—depends greatly, as we shall consider later, upon income and health; whether it will be enjoyable depends greatly on the personality of the individual—and upon contingencies.