The doctrine of defects in the self leads to a clinical focus on what is missing rather than on what is present in pathological organizatons of self-experience. Felt deficiencies in the sense of self may be understood not as manifestations of an irreducible internal defect within the person, but rather as the consequence of various organizing principles established in early transactions with caregivers. An illustration of this idea is provided by a brief description of the life and treatment of a young woman who felt that she had no self and that she did not exist.