This essay presents the case of a young man with severe posttraumatic stress disorder (PTSD) in order to demonstrate how a self-psychological orientation and psychotherapeutic approach enables acute symptoms to be relieved, while concomitantly addressing vulnerability in character structure. The self-psychological conceptualization of the psychodynamics of PTSD is discussed, along with a recently proposed neuropsychological theory of PTSD. After viewing the pertinent neurobiological research, an integration of the self-psychological concepts of transmuting internalization (a purported curative factor in psychotherapy) with neurobiological data and behavioral observations is presented.