Because cancer has been the leading cause of death in Japan since 1981, cancer is the most common and representative life-threatening disease in Japan. Previous reports have demonstrated that psychiatric symptoms, including anxiety and depression, are frequently observed especially in advanced and/or terminally ill cancer patients, and psychotherapy is one of the important treatment strategies for alleviating psychiatric symptoms among these patients. On the other hand, patients with advanced and/or terminal cancer suffer from various physical symptoms and are forced to face the continuous decline of physical function, and psychological defense mechanisms, such as denial, regression, and replacement, are frequently observed in these patients. Psychiatrists should provide an individually tailored and careful psychotherapeutic approach in consideration of the specific nature underlying advanced and/or terminal cancer. This paper summarized the previous findings regarding psychiatric symptoms in advanced and/or terminally ill cancer patients, and provided basic skills and a recommended approach to psychotherapy for these patients.