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In this paper, the author explores the clinical presentation of two patients who have recourse to fetishistic solutions. In one case, that of addictive sexuality, the patient is a foot fetishist; in the other, the fetishism takes the form of cross-dressing. In her discussion of the clinical material, the author develops issues raised by contemporary psychoanalysts concerning the Freudian metapsychology of perversion, the paradigm for which is fetishism. Contemporary ideas on fetishism have much less to do with sexual issues as such and more to do with the vicissitudes of primary narcissism: the fetishistic solution involves, above all, a primitive sense of identity that goes beyond sexual identification and object choice. The author then shows how some forms of so-called perverse sexual behaviour may in fact be an attempt to rebuild earlier deficiencies in the self's relationship with the primary object. With non-neurotic patients, the therapeutic process consists in bringing to the fore what was missed out in the primary organization of self-identity and in restoring the dimension of affect-failures that evoke the absence, in the primary environment, of any sharing of affect or mirroring potentiality. [ABSTRACT FROM AUTHOR]