This paper is about therapeutic work with David, a 13-year-old boy who, at the age of 5, was the victim of a hit-and-run road traffic accident resulting in quadriplegia. The circumstances leading to the accident and its sequelae reveal a particularly complex picture, which combines early emotional deprivation and trauma. Although cognitively intact and able to speak, David could not move. Yet he created movement in others through a desperate necessity, by communicating via the employment of extreme projective forces. The highly complex presentation of emotional, psychic and bodily damage in the child, and in particular, David's physical paralysis, has had a profound impact upon what I have come to think of as the 'mindbody' of the therapist. Winnicott has talked of the infant's 'psyche/soma'. Here I want to extend the notion and consider the bodily impact of projections in particular and how these have a powerful emotional and physical resonance on the 'mindbody' of the therapist, especially in therapy with a young person whose body is damaged. In this paper, I consider technical challenges and dilemmas encountered in the work, including the complex interplay of transference/countertransference phenomena. This unusual presentation of a boy in extraordinary circumstances led to considerations of psychoanalytic method and interpretative activity, which may be viewed as being inspired by 'emotional truthfulness '. 2 David, now aged 13, was the victim of a hit-and-run road traffic accident at the age of 5, and was left with permanent spinal cord injury. Since then he has become wheelchair bound and his head is supported by a chin rest, with which he operates the chair. His breathing and speech are aided by a tracheostomy (an air vent in his neck) and as a result, he often requires suction. The procedure involves a transparent tube being inserted into the vent in his neck so that the mucus and saliva that have collected are sucked out. David's speech is slow and often extremely difficult to decipher. A pacemaker regulates his heart and he is catheterised, has a colostomy and is often attached to a ventilator. David's physical survival is therefore dependent upon this life-support equipment. At the JOURNAL OF CHILD PSYCHOTHERAPY time of referral, David was also being fed through a naso-gastric tube as he had been refusing to eat, determined that he wanted to die. David's refusal to eat had continued for 6 months and he was receiving medication for depression. The child psychiatrist who had been working with David for a number of years had become increasingly concerned about his state of mind and referred him for psychotherapy.Before the initial assessment session, I had been given very little information about David's history, but I was told that he had been in a road traffic accident, which had left him paralysed from the neck down. As a direct result of this and other concerns about the parents' capacity to care for and protect their children, David and his siblings were received into care where they have remained...