The author of this paper presents therapeutic work with an elderly patient during the tenth and eleventh decades of her life. The author's focus is on the interplay of the creative, developmental and therapeutic processes in the revision of psychic structure. The paper depicts the experience of very old age, particularly the confrontation with mortality. It notes transference and countertransference reactions to the elderly patient. Poems the patient wrote during the last ten years of her life convey her experience of the described processes. The paper gives further confirmation to the recently acquired appreciation of the suitability of elderly individuals for psychoanalytic treatment.