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The aim of this paper is to contribute to the clinical neuropsychoanalysis literature. This clinical report explores changes to the mental apparatus of a patient presenting with conduction aphasia (the first such case to be reported from a neuropsychoanalytic perspective), and briefly compares it with the changes observed in other types of aphasia reported by Kaplan-Solms and Solms in their book, Clinical Studies in Neuro-Psychoanalysis. The case study examines the neuropsychodynamic presentation of a patient following ischaemic infarction of the left middle cerebral artery (MCA) territory. Specifically, it considers how damage to the left posterior superior temporal gyrus, which mediates the neuropsychological function of audioverbal analysis and synthesis, modifies the mental apparatus, and in which dynamic ways. The conduit d’approche, disrupted logico-grammatical thinking, and misuse of pronouns observed in this patient, consistent with conduction aphasia, are notable from a psychodynamic perspective, in that the disturbance of the patient’s ability to analyse and synthesize audioverbal structures appears to extend to her ability to relate things to one another in therapy, as well as to relate to the therapist. This difficulty thus poses a barrier to synthesizing elements of the therapy into a coherent whole and gaining perspective. The ability to regulate, relate, and synthesize all features of the therapeutic process and integrate them into new insights – an aspect of the work of the ego – appears to have been compromised. The apparently meaningful nature of the patient’s attempts to approximate language, as well as of her deficits in relational language (misuse of pronouns and logico-grammatical errors) is commented on. These difficulties manifest as a continual ordering and re-ordering of content in the therapeutic sessions and a continual lack of clarity, which impede progress. This paper is exploratory in nature.