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The North Wales Brain Injury Service was developed 20 years ago, to provide multi-disciplinary community-based neuropsychological rehabilitation to the residents of North Wales. The theoretical underpinning of clinical service delivery is an adapted, slow-stream Holistic Neuropsychological Rehabilitation model. Some of its key aspects include the provision of long-term psychotherapeutic follow-up, to facilitate psychological adjustment, self-awareness, and encourage self-management over time. While financial realities undeniably influenced the way this model was developed (the North Wales Brain Injury Service is a publically funded NHS service), an equally influential factor was a recognition of the central role that neuropsychoanalytically informed psychotherapy can play in post-acute neuro-rehabilitation. In post-acute rehabilitation settings, where working psychotherapeutically with problems of self-awareness towards psychological adjustment is central to the clinical model, the relevance of time over intensity of intervention is very important. Over the past two decades the service has evolved in several areas. While the service is multi-professional, this paper mainly reports on the nature of program developments as regards psychotherapy, resulting from the close collaboration of the North Wales Brain Injury Service with its local academic partner, Bangor University. In this context, five distinctive but inter-related themes of neuropsychoanalytically-informed approaches used in the service are discussed.