The case history of the psychotherapy of a heterosexual male cross-dresser provides an opportunity to examine some dynamics of power in the clinical situation, as expressed through the mutual construction of the transference-countertransference narrative. One aspect of these dynamics led to a confrontation with the analyst's narcissistic investment in the role of analyst. Another salient component of the case is a thinking-through of the creation and use of the fetish, in which gender and sexuality are intricately involved in the invention of a particular mode of relating. This exploration leads to an understanding of the fetish as functioning not only as a symbol but as a pervasive relational style.