(Accepted for publication 5 October 2016)

The author presents a case study of a hemophiliac boy in four-times-a-week analysis from the age of four to six and a half years. An extensive narrative of various phases of the analysis including the termination provides the reader access to the material for discussion of therapeutic action. Her analytic technique is based on a developmental point of view and illustrates the use of limits, play, and interpretation based on countertransference. She understands the boy's symptoms of preferring to be a girl, asking to cut his penis off, and wishing to die as defenses against the fear of castration, which in his case is aggravated by the actual threat of repeated medical interventions, and by the underlying fear of a lack of body composition. An unusual feature of the case is the illustration of the symptom, the analysis, and the recovery of the male self, captured in a complex collage that was made over the course of the relatively short analysis.