In this paper I explore the case of a woman, Miss M, whose twin died ‘in embryo’, employing as an extended metaphor Coleridge's Rime of the Ancient Mariner. Both the poem and Miss M's story describe ‘internal world’ dramas formed through very early object relationships. In Coleridge's allegorical poem we are told much about the poet's own inner world. The poem contains universal themes of destructiveness, loss and the quest for reparation; these themes illuminate the patient's story which was recounted by Miss M during assessment sessions for psychotherapy. The impact of her story, particularly its maritime images, formed many associative connections in my mind with the poem. The result for me was an enriched understanding of both the patient and the poem.