This paper situates a case history in the context of an emerging theoretical perspective, influenced by attachment research, that gives increasing weight to early real interactions. It suggests that the developing individual often has little choice in the kind of relational strategies that their early interactions unconsciously set up. The case history explores how this might have been the case for Marian, and asks to what extent such a patient can subsequently choose to modify her way of relating to others, as an act of selfcreation. It suggests that to a large extent this is determined by her current social context and the vicissitudes of a jointly created therapeutic relationship.