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This paper describes the progress of the five-sessions-per-week analysis of a twenty-one-year-old man, which started thirteen years ago and is still in progress. Since the patient presents a case of high-functioning ASD, albeit with quite distinct autistic mechanisms and features, he can provide us with many insights regarding the difficulties and satisfactions of emerging from an autistic universe into the world of communication and relationships. The patient’s journey went through three main stages: autistic encapsulation, autisto-psychotic defensive organization, and, finally, manic-perverse pathological organization, with severe obsessive-compulsive defenses that help him ward off the pains and anxieties of otherness and dependence. Central to this patient’s journey is the “dilemma of treatment,” namely accepting the analyst’s proposed “cure” over his own autistic self-generated, omnipotent one. This dilemma can often deteriorate into a standstill that might even result in a negative therapeutic reaction. However, if we keep in sight the patient’s deep anxieties concerning change while, at the same time, relating them to his aggression, destructiveness, and omnipotent-perverse need for a new protective structure, some further benign object-related changes might emerge. This calls for the analyst’s acknowledgment of his responsibility for the inevitable anxiety and pain he is causing the patient with his analytic “cure.”