I have elucidated some of the main clinical and theoretical currents of the last few decades which belong under the general heading of 'alteration of the ego due to defensive processes', making use of Freud's dynamic structural concept. As examples of pathologically altered structures which connect all or some of the functions and agencies of the personality and rule as a state within a state, I have adduced the neurotically ego-syntonic character, a narcissistic defensive organization and the psychotic part of the personality. The possibility of therapeutic change depends on whether the pathogenetic path that led to the formation of the prevailing self-object relation can be retraced in the transference. The retracing of the ego-superego disturbance to its traumatic origins and the facilitation of a therapeutic regression are old-established basic psychoanalytic concepts which go back to Freud and Ferenczi and which, it seems, at present allow a synthesis of the clinical experiences gained under the aegis of different theories.