Via the role of fantasy, we propose a theoretical integration. Specifically, we focus on the pathologically conflicted aspects of sensual-sexual and aggressive strivings as well as the self-organizing and reparative aspects that contribute to fantasy formation. We present key aspects of Kohut's thinking to set the stage for a self-psychological view of fantasy. We also discuss contemporary self-psychological positions on fantasy. We suggest the limitations of this single motivational focus and then provide a rationale and research data supporting the inclusion of sensual-sexual and aggressive strivings as contributors to fantasy formation and maintenance. Anecdotal and clinical vignettes are offered to suggest different pathways that specific motives take to initiate and sustain fantasy life; we demonstrate, as well, the intertwining of motives. We maintain that such a theoretical consolidation lends efficacy to clinical work.