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This paper discusses children who initially may seem suitable for psychoanalytically oriented treatment but who do not respond in the anticipated manner. Such difficulties in treatment may suggest the presence of a narcissistic disorder. Clinical material from a latency-aged girl is presented to demonstrate the typical difficulties encountered in maintaining a working relationship with such children, and the special frustrations and countertransference issues that are apt to arise. A set of criteria is proposed to help in the diagnosis of a narcissistic disorder, and a treatment approach is suggested.