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Using ideas derived from Dana Birksted-Breen (‘Phallus, penis and mental space’, International Journal of Psycho-Analysis, 77: 649–57, 1996), this article explores the clinical experience with ‘Tommy’, a young boy who suffered multiple traumas and neglect. Birksted-Breen describes a phallic state of mind, which, amongst other things, serves to repudiate the potential for a creative link between internal parental objects and a capacity for thinking. In order to survive psychically, Tommy frequently turned to a phallic state of mind. The deficits in his internal and external objects meant that helpful parental qualities, linked with the development of psychic bisexuality, were not available for introjection and identification. The paper suggests a link between Tommy's employment of phallic (and at times perverse) ways of thinking, related to his intrusive attempts to expose and humiliate his psychotherapist, and to an experience of shame associated with inadequate internal objects. The serious compromise to the development of a creative psychic bisexuality in the patient is reflected in the countertransference strain on the psychotherapist's own internal couple.