This paper presents psychotherapy with a mother-child couple in which the little boy was originally diagnosed as autistic. The case was based on psychoanalytic understanding, but symbolic interpretations to analyse unconscious dynamics activated in the transference were not used, because the child was not able to use his mind to ‘think’ in ways appropriate to his age. The technique was adapted to circumstances that included the reduced comprehension of the child, his pressing developmental needs and the narcissistic personality of the mother, together with her lack of empathy. Interpretations were directed to both of them, in order to promote, simultaneously, the child's development and the couple's capacity to relate to each other. The child progressed rapidly and the symptomatology receded. With hindsight, the presenting autistic symptoms can be ascribed to the early onset of pathological defences as a consequence of illness and separation during the first week of life.