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Originally psychoanalytic understandings concerning the capacity to tolerate otherness were linked to the concept of narcissism. Freud (1914) had originally identified a protective stage of ‘objectless’ primary narcissism in normal development and a secondary narcissism, which involves a withdrawal of attachment to the external object. Recent theoretical understandings have identified very early stages of development, known as primitive mental states, wherein the other is both poorly differentiated and psychically represented, leading to unique anxieties and defences. I wish to demonstrate how in working with such states of mind associated violent exigencies can emerge, which if not identified and carefully managed, can stymie psychic growth. In managing such exigencies, it is proposed that the therapist needs to be available to the patient as what Bick has termed a ‘complex undifferentiated object’. This leads to a way of navigating the point at which the patient can suddenly switch from a desperate need for such an object, to a fear of being annihilated by it. In this process, the value of identifying primitive anxieties through one's somatic countertransference experiences is highlighted, as is the utility of a continuum of developmental anxieties, initially proposed by Ogden (1989), which can be used as a therapeutic compass in such a clinical landscape. Two case vignettes are presented which demonstrate how the presence of the therapist moved from being imperative to the patient's survival to being potentially annihilating, and how this was worked with to facilitate psychic growth.