With the help of several clinical vignettes from the literature, the clinical consequences of the theoretical system of self psychology are examined. In that system pathogenic primacy is given to failures in parental empathy, leading to the technical requirement of providing empathic responses which build a cohesive self through transmuting internalizations. Efforts to extent the application of self psychology to include the psychoneuroses lead to an interactional reparative therapy that compromises interpretation of transference and resistance. Therapeutic change resulting from this approach is seen as essentially different from the processes and transformations set in motion by classical analysis.