Clinical psychology is developing into an integral part of modern health care delivery systems as evidenced by its role in the establishment of services in clinical psychology in general hospitals, training programmes in medical psychology, and the increased teaching of medically applied psychology in medical schools. This extended role of clinical psychology is discussed against the background of a subspecialization in psychonephrology. The aim is to illustrate the development of psychological treatment for chronically ill patients with end-stage renal disease, in the context of a developing country with a multi-ethnic society.