Based on their experience in a “care-study” day hospital, the authors offer a theoretical and clinical reflection on the place of the dual relationship in psychopathology and the treatment of patients suffering from narcissistic and identity-related problems. While the dual relationship is often viewed with suspicion, the institutional context providing the dimension of thirdness that is thought to be lacking, it seems to be an unavoidable necessary stage in the therapeutic process which may be likened to conceptualizations of the transference with its two stages of sexualisation and desexualisation. The authors thus identify three necessary stages in the evolution of their young patients: first, the hypercathexis of one of the objects of the environment or of the idealized setting, second, disappointment and attacks on this object, and third, extrication from this negative relationship and introjection of a part of the elaborative work of the caregivers. This reflection is illustrated by a number of clinical vignettes of these different stages.