The analyst's loyalty to a single paradigm is sometimes challenged by certain recent developments in psychoanalytic theory-making. Among these are (1) a trend toward metatheory, in which theories are formulated at levels of abstraction that can encompass concepts and technical recommendations from multiple theories; (2) expanded opportunities for influence among authors from diverse theoretical orientations; and (3) an emphasis on qualities of engagement between patient and analyst, which highlight the analyst's unique subjectivity and self-expression. For instance, the analyst's authenticity, spontaneity, creativity, playfulness, humor, and empathy (used as a guide to action) can lead to more affective and improvisational interactions between patient and analyst and to a theory's seeming to play a lesser role.

Using clinical fragments and an extended vignette, this paper explores some of the ways that these intersecting theoretical developments can affect the treatment, the patient, and the analyst's ways of thinking about her work.