A multifaceted mode of therapeutic action is delineated as the complex neuropsychological and psychogenic factors in the development and functioning of an unusual four-year-old boy became elucidated. In addition to standard technique, the author developed a variety of psychoanalytically informed ways to facilitate his growth and ameliorate deviational aspects, especially his difficulties in appreciating and responding to the social-emotional world and establishing stable, integrated mental representations of self and other. The evolving treatment process is presented as well as attempts to coordinate and harmonize analytic and developmental goals.