This paper describes intensive psychotherapy with a 3½-year-old boy who had come close to death at 10 days old, with urinary reflux and meningitis. The paper describes the way in which Jamie protected himself from unbearable terrors by being in identification with a builder. It tracks the way in which containment in the therapy allowed him to begin a process of experimenting with different identities through engaging in pretend play. The latter part of the paper looks at Jamie's subsequent development and examines the links between trauma and inconsistencies in his capacity for symbolic thought.