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The author explores the clinical problem of narcissism by discussing a patient who was seen privately for once-weekly therapy for a period of two years. The emphasis is on trying to understand the nature of this pathology and the difficulties it presents to the therapist, especially in the transference and countertransference. The clinical material is examined in the light of theoretical concepts relating mainly to pathological organizations of the personality and perversion. The viability of working once weekly with such patients within a psychoanalytic framework is also considered.