The article concerns patients in whom, at the initial stage of therapy, a diagnosis of narcissistic personality was considered, whereas during the course of the therapeutic process, a picture of schizoid personality co-occurring with neurodiversity traits (ADHD, autism spectrum) gradually emerged. I present fragments of psychotherapeutic processes conducted in a psychodynamic approach with adolescents and young adults. Their common denominator is the experience of strong, often overwhelming feelings of pressure – both on the part of the patients and the therapist. The starting point for understanding the described issues is the search for the sources of this pressure, that is, the analysis of the configuration of defense mechanisms and transference-countertransference phenomena in connection with neurodiversity traits. In the description, I rely on experiences from therapies I have conducted with adolescents and young adults. In defining the concepts, I use psychoanalytic and psychodynamic approaches to schizoid personality (McWilliams, Kernberg, Johnson), Tustin’s concept of autistic defences, Mollon’s notion of self-objects as the psychological substrate of ADHD traits, and Klein’s concept of the schizoparanoid position. The aim of the article is to demonstrate how neurodiversity co-constructs specific configurations of defense mechanisms and may facilitate the development of a schizoid personality configuration, and what implications this has for the course of psychotherapy under pressure.