The author examines the interplay between neuropsychological dysfunction and psychological conflict. Two ideas are emphasized. First, clinicians may overlook or subtly de-emphasize the contribution of neuropsychological dysfunction to patients' difficulties. Second, when neuropsychological difficulties are diagnosed, there is value in being acquainted with the details of the dysfunction and exploring the specific ways in which they are elaborated in fantasy and interwoven in the patient's psychodynamic constellation (including their employment for defensive and superego purposes). This perspective is contrasted with more general formulations concerning the patient's experience of her/himself as damaged. A case serves to illustrate such a clinical process of discovery.