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This article examines the clinical importance of distinguishing between expressions of healthy expansiveness (or healthy forms of grandiosity), on one hand, and expressions of archaic grandiosity, on the other. Kohut’s depiction of these two very different affective states as both being manifestations of “the grandiose self” results in a generalized treatment approach wherein the mirroring self-object function of the analyst applies to both states as they present themselves in treatment. However, these two distinct states often appear simultaneously in treatment and require more nuanced and careful delineation by the analyst. This article compares Kohut’s theory of the grandiose self with a treatment perspective that privileges a distinction between the affects and contexts associated with grandiosity as it is manifested in healthy expansiveness, and grandiosity as it is employed defensively. By not making a clear distinction between healthy grandiosity and defensive grandiosity, the analyst can inadvertently support and encourage the latter. A treatment approach is illustrated with clinical material that focuses on the patient’s and the analyst’s affects associated with these distinct expressions of grandiosity, along with the careful tracking of fluctuating states of grandiosity within the context of the shifting dimensions of the transference.