Accompanying a male adolescent out of the darkness of being unable to differentiate between inside and outside, between being a boy or a girl—the psychoanalytic journey is described from both a clinical and a theoretical perspective. Based on Sigmund Freud's metapsychology, psychoanalytic concepts such as regression, defense mechanisms of the ego such as projection and introjection, and features of the primary process are illuminated. Special emphasis is placed on changes in body schema and the role of language in reality testing. The therapeutic process cannot be understood without reference to the psychoanalytic concept of the ego and its early development. Using neuroimaging evidence, results of neuropsychological assessment, and excerpts of the ongoing therapy sessions, the pieces of the boy's history are put together alongside the reconstruction-surgery of the frontal cranial bones.