The author describes his experience with patients who use activity and self-control to fight off painful internal affects. These behavior patterns reflect powerful narcissistic defenses guarding against rage, grief, and retraumatization in object relatedness. Treatment may begin with cooperativeness, but become stuck. These problems can be understood and dealt with more effectively today because of the variety of theoretical models available for understanding what is going on in the patient and in the intersubjective, transference–countertransference aspects of the relationship. In particular, it is important to be able to move between an actively loving engagement with the patient's unexpressed dependent longings and a firmly confronting challenge to the destructiveness of the defensive stance.