This article illustrates the development of a working alliance between a psychoanalytic psychotherapist and a four-year-old girl, Elsa, diagnosed with Asperger's syndrome. From the beginning, intense anxiety related and reactive to Asperger's was central to the treatment process. My nonimpinging presence and curiosity, and use of transference–countertransference phenomena were central in the development and deepening of the therapeutic relationship. In the encouragement and safety of the three-times-weekly therapy schedule, Elsa began to play out her fantasies, which led to a process of active developmental growth. Over the course of the first three years of treatment, Elsa became more openly involved in the therapeutic relationship. Her anxiety diminished as she began to tolerate her own affective experience. She began to experience greater success and comfort in social interactions with her family and other people in her life.