During a successful course of psychotherapy, deficits in ego structure are exposed, identified, and healed. Much trauma is experienced during the preverbal stages of ego development. These stages are reviewed in Althea Horner’s model and include symbiosis, hatching, practicing period, and rapprochement, culminating in libidinal object constancy. Vaillant’s model of the hierarchy of ego defenses in psychopathology is reviewed with a revisionist eye towards ego defenses as a reaction to trauma in childhood, especially denial. Therapists are encouraged to look at how their own ego issues and defensive styles impact attachment in therapy for clients with similar or different styles.