This study explores the nature of the need for counselling/psychotherapy for older people who suffer a debilitating physical injury or illness. This topic is investigated within a medical setting where the emphasis is on physical rehabilitation. The relevance of this inquiry is highlighted by the paucity of literature about the individual impact of such an event and the need for counselling/psychotherapy in these situations. Theories, on the ageing process, the body, and the self, are used to develop an analysis of the material. The suitability of a research method is considered, with particular reference to inquiring into a contemporary phenomenon within a real-life context. A case study approach (Yin 1994) utilising narrative analysis (Riessman 1993) and metaphor (Lacan 1968) was the method chosen to conduct the study. In the data, presented in the form of interviews and cases, there is a sense of each person grappling with a new experience of self. Through analysis of the data, emergent themes termed "encounters" were developed which reveal the need for counselling/psychotherapy in these situations. These "encounters" show the shock of a disabling illness and the reality of the patient's fears of incapacity and death. A complexity of losses are also identified, some of which engender feelings of anxiety, helplessness and isolation. The study includes illustrations of how the creative and imaginative use of metaphors can help people explore new meanings and openings to re-establish a sense of purpose and meaning in life and hope for the future. Other ways of working are introduced and suggested, for instance, guided imagery and visualisation, and the use of meditation. Some areas indicated for future research include the role of group work with older people in medical settings and the role of counselling/psychotherapy with regard to relatives, carers and staff, Implications for future counselling/psychotherapy training are also provided.