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This paper describes the second attempt to offer a patient psychotherapy after a previous psychotherapeutic treatment failed. The patient's presenting difficulties were of dissatisfaction with life and specific problems in thinking and in understanding the use of metaphor. The patient's father had survived five years in a concentration camp but the significance of this fact had been overlooked in the first attempt at therapy. The literature on the families of survivors highlights how there is often an embargo on talking about life in the camps. The inability of the survivors to process the experiences symbolically can give rise to a defect in the ability to understand symbolism and use metaphor in their children. This can result in unconscious pre-symbolic enactment of aspects of the reality of the concentration camp situation, in the present-day life of the child. However, it was difficult to establish whether the patient's defect in symbolic capacity was due to transmission of the Holocaust trauma or had evolved for reasons more related to other developmental difficulties. These problems of differentiation are illustrated in the clinical material and are further discussed in connection with the conceptual, diagnostic and therapeutic issues involved.