In many instances an encounter in which patient and analyst engage in relatively direct and personal ways is the key to a viable process and the locus of therapeutic action. Where the analytic integrity of the work is threatened an encounter between patient and analyst can become the heart of the work, as the analyst's insistence on what is incumbent for productive treatment becomes the analytic lever. The premise is that there is a difference between facilitating an opportunity to deal with destructive or regressive emotions or impulses in an analytic way, which can be a healing and integrative experience, and allowing these to be acted out, which can be undermining and which can create iatrogenic problems.