This paper presented a clinical study about the role of the internalization of the patient–analyst relationship in the repair of developmental defects in five patients with narcissistic disorders. The study was done by integrating and correlating events occurring within analytic hours with reports of fantasies patients had about the analyst outside of analytic hours.

The internalization of patient–analyst transactions was described as including two transformations. The first was the replication of patient–analyst transactions in their analyst introject fantasies. Most significant was the deferred imitation in fantasy of the analyst's observational and interpretive activities. The second transformation involved the patient's development of new or improved ego and superego functions through selective identifications with the object representation of the analyst.