The process of change can be understood from a variety of perspectives. Using the case of a self-mutilating woman whose educational, social, and psychological impairments resulted from years of childhood abuse and neglect, this article demonstrates an object relational perspective whereby internalized “bad” self and object representations are modified and replaced by more benign internalizations. Additionally, a wide variety of techniques are suggested and illustrated, including those that represent our strong social work training coupled with interventions that are more usually associated with psychodynamic psychotherapy.