The patient was twenty years old when he entered an active treatment mental hospital in the hope of averting lifelong custodial care. He had suffered brain injury in an automobile accident in his eighteenth year. Before this event, he may have been depressed. His academic skills had been suboptimal, he had behavior problems, and he had misused various substances. The accident was caused by his driving while intoxicated. His intellectual skills were significantly impaired by the brain trauma; for example, he had trouble remembering names and events, he had regressed to a preverbal, preoedipal emotional state, and he was unable to bear the slightest frustration or to control his impulses; his substance misuse escalated. The author delineates in vivid detail the course of the first ten years of intensive dynamic psychotherapy in which the principles of child psychotherapy were applied to help