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Methuselah is the elderly patient and Echo is the admiring soul, the therapist, who gives Methuselah back to himself by joining, mirroring, and reflecting in the course of creating a treatment alliance. Dr. Bouklas brings transpersonal, psychodynamic, and behavioral approaches to bear on the existential problems of old and late old age, promoting a vision of healthy narcissism in the frail and ill elderly, of regression in the service of transcendence. He demonstrates how to implement and integrate these approaches in the spirit of increasing patient self-awareness, and his vivid examples reveal the inspiration and wisdom to be gained by working with the elderly.