The study of primitive patients, i.e. patients with borderline and narcissistic personality disorders, is utilized to examine the concepts of transference, the real relationship and therapeutic alliance in the treatment of all patients. Self-object transferences are present in the psychoanalytic treatment of primitive as well as neurotic patients. In neurotic patients they form the silent stable framework upon which the neurotic dyadic and triadic transferences emerge.

The complex meanings of the patient's real relationship with the analyst are explored. In primitive patients the real or objective qualities of the analyst are perceived after self-object transferences are established. These objective attributes are then available for internalization if they are deficient and needed by the patient.