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Levine describes, with detailed clinical examples, a group of patients who do not have a firm and cohesive sense of self and have not obtained libidinal object constancy. The continued durability of the self and the object is therefore contingent upon a continued relationship with a real or fantasied object, which Levine calls the sustaining object relationship. Since this object is so important to patients, they must attempt to control it because the loss of the relationship can be life-threatening. But at the same time, the fear of engulfment, the wish to merge, and the fear of retaliation that such a relationship may produce can be equally threatening. The author feels that a "narcissistic alliance" is essential for treatment of these patients, one in which the analyst can assume the role of the sustaining object until gradual stability of the patient's self and object world can be achieved independently of the analyst's function. At this point the analyst can return to his function of analyzing in the usual way those intrapsychic conflicts that produce neurotic symptoms and inhibitions. In a discussion of this paper, Tolpin differentiates patients who have disorders of self-cohesion secondary to regressions from those who have true disorders of the self. In the former group, it is really preoedipal pathology that serves as a defense against phallic-oedipal conflicts, and those patients should be analyzed in the classical way. However, in the other group, with primary pathology of the self, the correct treatment requires the development of the self-object transference and its gradual interpretation through transmuting internalizations. In his well-reasoned rejoinder, the author points out that one cannot so sharply separate preoedipal regressions from primary pathology of the self. There are patients with a mixed picture of predominantly oedipal-preoedipal problems together with primary pathology of the self. Levine also properly questions the idea tha