Therapy with seriously dissociated patients requires the transformation and integration of malevolent ego states that produce a wide assortment of negative experiences and behaviors in the patient. During the course of therapy, they can present dangers to both patient and therapist, as well as to the therapeutic process (Watkins & Watkins, 1984). Perhaps the greatest challenges for therapists in this work are the development and the maintenance of empathy for these personality aspects. Without some degree of empathy, a healing therapeutic alliance cannot be formed, and absent a secure, healing, intersubjective experience, it is unlikely that malevolent ego states can undergo sufficient transformation for integration. Essential elements for developing and sustaining both the necessary empathy and the compassion, the altruistic activity that empathy engenders, are presented.