Rosenfeld presents clinical material to illustrate that the ideal self-image of the narcissistic patient is a pathological structure based on omnipotence and denial of reality. In therapy it is rigidly protected against and assumed to be endangered by insight or contact with reality. The clinical result depends on the degree to which the patient gradually accepts the relationship to the analyst as representing the mother in the feeding situation and consequently accepts the problems of separation, frustration, and a working through of the depressive position (Klein).