Pathogenic expectations and beliefs are constructions of reality, usually unconscious, that link frightening outcomes to the pursuit of normal developmental goals. These expectations, derived from past painful experiences, are conceptualized as a root cause for symptoms, repression, and other defenses. The first 5 years of an analysis are presented here to demonstrate how treatment technique is affected by an understanding of pathogenic expectations and beliefs as organizers of psychic reality and psychopathology. The major mutative force in this beneficial treatment was a process of gradually disconfirming the patient's expectations within a treatment relationship that the patient perceived as offering acceptance and empathic explanations of her psychic reality.