Past psychotherapeutic approaches to posttraumatic stress disorders are discussed with reference to some of the special problems in treating the disorder in Vietnam combat veterans. In some cases therapy oriented specifically to the effects of combat trauma can be helpful even in veterans seen years after combat; in others the symptoms have become so enmeshed in the veteran's life that trauma-oriented therapy must be combined with more traditional psychotherapeutic principles. Three cases representing a range of the ways in which posttraumatic stress is experienced are presented and their treatment is discussed. These cases illustrate the importance for effective psychotherapy to be based on an understanding of what the combat experience has meant to the veteran and how such meanings continue to be represented in the individual's postwar life.