This paper shows the theoretical similarities between Harm Reduction Psychotherapy and Heinz Kohut’s Self Psychology, and delineates how each of these clinical perspectives complement and enhance one another. Using these two theories in tandem provides further opportunities for clinicians to treat a larger proportion of the substance using population not yet ready for cessation or abstinence. A case involving crystal meth addiction is presented, and aspects of the treatment are explicated including identifying the self-regulatory and symbolic functionality of substance use, and working with the patient’s own ambivalence about his behavior. A self- object “twinship” is also highlighted as having an important mutative impact on the treatment.