A female patient in her 20s with a history of repeated hospitalization for selfmutilation is presented. Countertransference clues prompted reexamination of the patient's symptoms and suggested an identification with an aphasic, hemiparetic parent. The case presented focuses theoretical attention on the interaction between processes of pathological identification and neuropsychological dysfunction. A proposal is made to broaden the concept of identification to include potential variations in neurological, somatosensory, and intellectual function as they may interact with changes in affect. Implications for theory and treatment are explored.