This paper describes intensive psychotherapy with a twin born very prematurely and in traumatic circumstances. When referred at the age of 3 the trauma was manifesting in prolonged bouts of nightly head banging. The issue of an adaptation of established technique is explored. Drawings, initially the therapist's, but invested by the child with unique identifying features, were crucial to the development of his thinking, offering a means of bringing internal and external worlds into a coherent relationship.