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In this preliminary qualitative study, we suggest that the synergy of psychoanalysis, neuroplasticity, and the homeostatic imperative enables brain-injured patients, an underserved population, to achieve what we have termed a “reparative adaptation,” meaning the ability to maintain a sense of self and to move forward with creativity and flexibility. A review of clinical case reports of the treatment of brain-injured patients was conducted, providing evidence in this preliminary qualitative study that a neuropsychoanalytic perspective can address not only the cognitive and behavioral results of brain injury but also the psychological challenges. We discuss five clinical findings: the impact of cognitive impairments on psychodynamics; awareness and identity issues; sense of loss; grief and mourning; and reparative adaptation. In addition, we report three technical findings related to the working alliance, the importance of psychoeducation, and alternative modes of communication. This preliminary qualitative study provided evidence that the efficacy of the neuropsychoanalytic perspective in working with brain-injured patients further substantiated a treatment modality that might be effective with other patients as well.