Work in fantasying, active imagination, or in the mind's eye can sound like a game or ineffectual to some people. However, any action done in fantasying is equivalent in intention to acting in the real world. For those who don't understand that thinking is based upon action another indication of the seriousness of this approach is that some patients can't perform certain actions in fantasying. With an echoist, aggression can sometimes feel wrong or even impossible in fantasy. I believe I've posted about this before, but sometimes an animal or non-human must express the aggression the patient feels towards another person. In witnessing the non-human attack the object of anger or hatred the person feels a release.
This release gives expression to how echoistic empathy and idealization can be so strong that the patient is impotent, avoids conflict of any kind, and is psychologically Christ-like in terms of resisting others. The person is forced to only be able to forgive others for their trespasses or see aggression in the world or from loved ones as being caused by demons or spiritual forces that take over others.
For some narcissistic, or more precisely, primary narcissistic patients (the echoist above is primary echoistic too), affection is similarly blocked. Even though their family may represent others who are related to the self and therefore don't invoke the same anxiety which non-family does, they don't show affection to family. The family still registers as part of self, but there is a defusion which means that there's ambivalence. Such primary narcissists can also construct cute animals and non-humans that represent affection with which they can identify in order to bypass their affection block.