The contrast between “conflict” and “deficit” models of psychological disturbance, their relative weight in any given case, and the nature of their interrelatedness have persisted as topics of both clinical and theoretical interest. Given the development of neuropsychological constructs as useful explanations for some aspects of the “externalizing” disorders of childhood, there appears to be some risk of lessened attention to the role of intrapsychic conflict in such clinical presentations. Using clinical material from the treatment of a severely behaviorally disordered inpatient youth, I present a case for the ubiquity of conflict in such presentations and its interpretation as an aid in symptomatic improvement.