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The author presents a detailed report of the dynamic psychotherapy of a boy who suffered from severe pathological narcissism. He then offers a set of precepts to guide the clinician in the psychotherapy of narcissistic children and adolescents. They are characterized by the therapist's respectful attention to the patient's exquisite narcissistic vulnerability. Since these young patients tend to insist upon full control over their sessions, the therapist begins by being an admiring spectator, refraining from early interpretation of any warded-off feelings of envy or vulnerability. The first therapeutic task will be to establish an area of mutual interest in which therapist and patient may relate safely. In the middle phase, the therapist may encourage the child to consider expanding the range of sharable experiences; this will call to the young patient's attention that the major portion of his or her life has been denied and never shared. This opens the door to systematic exploration of the child's defenses against feelings of narcissistic vulnerability. In the final phase, the child will have an opportunity to test his or her readiness to relinquish these defenses, particularly omnipotence. If all goes well, the child will then deal with the sadness and loss associated with termination.