Using the 7-year psychotherapy of a Holocaust survivor, this paper explores the sometimes contradictory aspects of approaches to trauma. Conceptualizing a “self in pain” as an alternative to contemporary conceptualizations of the traumatized person as having a damaged, dissociated or collapsed self leads to a corresponding alternative clinical approach. The paradoxes of traumatic memory and testimony necessitate an adaptational emphasis and the emergence of a “doubled” in contrast to a dissociated self. The decision to respect this “doubled” self involves a privileging of “reality” over “psychic reality” which then, paradoxically enables this patient to develop a phantasy life.