From the analysis of a developmentally delayed 6-year-old girl, with possible organic complications and with some mild autistic features, the author shows how the internal organization of space is related to the perception of relations with real external objects and between these objects. Conversely, the internal configuration of space and object relations influences the way the outside world is known and experienced. The inner world of this little girl was characterized by the complete concreteness of her ideas, and by a two-dimensional conception of space, used to defend against intrusion by persecutory figures. In the therapeutic relationship this was the cause of enormous difficulties both for verbal communication and for initiating change. The author explains how, through the expression of her own countertransference to the child, communication was established and lasting change achieved.