Three therapeutic modalities are defined in terms of the analyst's level of listening, formulating, intervening, validating, and relating. These are identified as working with (a) manifest contents, (b) Type One derivatives (isolated inferences from the patient's material), and (c) Type Two derivatives (material organized around the prevailing precipitant or adaptive context—as a rule, the analyst's attitude and interventions). The curative factors in the first two modes of therapy are conceptualized as barrier systems designed to seal off the most pertinent and chaotic truths within both patient and analyst. The curative elements in the third mode is seen in terms of dynamically truthful realizations providing access to the most compelling actualities, both conscious and unconscious, within the ongoing, spiralling communicative interaction between patient and analyst. The development of these ideas are traced out, the necessary concepts defined, and illustrations are drawn from the literature and discussed. The implications of these proposals are then considered.