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“Pathological identification” is a learned, psychological phenomenon in which patients unconsciously repeat pathological behaviors, attitudes, and affects their parents displayed in the past causing current problems in relationships with spouses, children, coworkers and friends. This phenomenon explains a wide range of pathologies that occur in everyday life that present frequently in psychotherapy and is often a hidden cause for patients failing to get better. The perspective on pathological identification developed in this article was first described by Joseph Weiss, who noted that patients unconsciously repeat their parents' mistakes as a way to protect them and maintain an attachment. This article goes further to suggest that patients may reenact their parents' problematic behaviors to avoid being aware of what their parents did to avoid their own scornful feelings in response, ultimately to protect parents from potential rejection or abandonment. This article traces the developing concept of pathological identification by writers including Sigmund Freud, Anna Freud, W.R.D. Fairbairn, and Joseph Weiss. It reviews the literature on how children protect their dysfunctional parents and the important role of altruism and loyalty in creating psychopathology. Based on this conceptualization, psychotherapy can help patients relinquish pathological identifications. How the therapist can recognize pathological identifications and the implications for treatment technique are illustrated with clinical examples.