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This paper considers the impact that a once-a-week therapy had on a patient with a borderline-narcissistic type of personality organisation. The patient described, a 50-year-old woman, came to treatment following a depressive breakdown. The three-year period of psychotherapy seemed only to have made her de-compensate even further; her defensive organisation continued to weaken. Yet, with the announcement of the end of treatment, a recovery started to occur. The theory of the life and death instincts, from its conceptualisation and development by Freud, through its later evolution, is used as a conceptual framework to understand the powerful struggle within this individual between those forces pulling towards growth and development, and those pulling towards destructiveness and deterioration. The case is discussed not only with this theory in mind, but in the context of personality structure and of what happens when a patient's defensive organisation is diminished through therapy. The ‘pros and cons’ of psychotherapy are considered, with special attention being paid to its implications for time-limited therapy within the NHS.