Cognitive differences and deficits are a fact of life, but this fact has not been highlighted in contemporary psychoanalytic theory. Using the self psychological concept of Kohut's tension arc as an example, this paper suggests that theoretical modifications are necessary to understand and therapeutically work with patients with learning deficits. Specific practical suggestions are made about how to therapeutically help individuals who struggle with these differences in psycho-biological loading. Clearly, the inclusion of biological variables in psychoanalytic theory will lend itself to further study of how nature and nurture interact at various levels of the neuraxis.