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This is the case of a suicidally depressed, anhedonic woman who came for psychoanalysis. In the third session, she gave the psychiatrist an essay in which she revealed in graphic detail both her violent fantasies about him and her belief that he had agreed to treat her in order to cure himself of his own pain. These themes persisted in the treatment. The analyst frequently experienced himself as harassed by the patient to do as she wished in the sessions. He often felt violated by and fearful of her; he also found himself behaving sadistically toward her. Eventually, the treatment focused on their mutual perfectionism and their hatred of one another. The analyst first viewed them as projections of the patient's attitudes. He believes that when he owned and dealt with these projective identifications as psychic elements that had become part of his own self through the mechanism of transmuting internalization, he was able to help the patient recover from her serious mental disorder. The authors conclude that the optimal psychotherapy setting for regressed patients is one in which ambiguity and uncertainty are actually experienced by both members of the treatment dyad.