This paper explores the challenges and developmental opportunities of working with the sexual transference in psychotherapy with adolescents. Psychoanalytic contributions investigating the nature of adolescent sexuality and the developmental move from a narcissistic organisation to a capacity to form intimate relationships are reviewed, and the question of what happens when there is a lack of containment in infancy is addressed. The way in which unintegrated sexual impulses and phantasies can invade the therapeutic relationship is further discussed through the account of the weekly psychotherapy of a 16-year-old boy who formed a powerful sexual transference to his female therapist. The paper highlights how working through the sexual transference enabled this young man to face his developmental paralysis and begin to use the therapy as an opportunity for psychic growth.