The author argues that psychotherapy for aged & other suicidal patients must rest on a careful formulation of the subject’s specific narcissistic incapacity. The therapist must begin with a careful scrutiny of the subject’s history & then must determine the present risk. Treatment must often commence on the inpatient unit & involve medication or electroshock therapy. A supportive psychotherapy provides the self-functions that the subject cannot muster. 2 case examples are presented.