In a coherent psychoanalysis, clinical language must be compatible with psychoanalytic theory and metatheory—the model of mind. The concepts of desire and symbolization are fundamental to the psychoanalytic model of mind, and this requires that we understand that behaviors and acts are indeed enactments: symbolic acts carried out as the consequence and manifestation of desires in turn derived from basic drives. Yet this sets up some puzzles where concepts valuable for expressing analytic facts and insights are in some tension with the general model of mind. One is that of substitute satisfaction: How exactly are we to understand this? The second, related to the first, is that of phantasy which is widely taken to be the realm within which substitute satisfaction works to effect some pacification of the underlying desires: How may we retain this important notion without undermining the realism of the psychoanalytic metapsychology?