The author agrees with Pickles concerning the emergent quality and unpredictability of what occurs in any treatment relationship, seeing these qualities as opening the door for either destructive or constructive relational forces to be set in motion. It is the analyst's striving for attunement and understanding through all the surprises, good or bad, that can determine whether what emerges is ultimately therapeutic for the patient. The author discusses “identificatory processes” in the writings of Loewald and Kohut. She distinguishes between positive and negative identifications and elaborates on the latter, suggesting how these can enter and undergo change in a treatment relationship.