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This paper illustrates one kind of ‘impasse’ in psychoanalytic psychotherapy described by Rosenfeld (1987 [1995]. Clinical illustrations from the experiences of two adolescent patients are given. The author emphasises that perversion reinforced the confusion these patients felt in the transference and in their lives outside treatment. An internal combined object, with features of a fetish, enhanced the influence of destructive narcissism. A fetish, comprising good and bad features in a confusing way, induced states of mind that tended to hold each patient in an impasse. The author suggests that such enhancement of the organisation of narcissism may account for some characteristics of ‘psychic retreats’ described by Steiner (1993), and the ‘as if’ quality of some treatment relationships described by Britton (1998, Belief and Imagination; London and New York: Routledge).