Pathologic character formations of various kinds can be organized around academic success. In a group of such patients, doing well at school was found to be a continuation of attending to the needs of a mother who used her child narcissistically. Often the mothers were depressed and turned to the child for solace, ignoring the child's needs. Sensitivity to nuances of the therapist's mood and efforts to please dominate the patient's participation in treatment, resulting in countertransference hazards. The work of Winnicott and Khan helps conceptualize the developmental difficulties experienced by the patients.