The symbol 'R' denotes the analyst's total response, conscious and unconscious, to his patient's needs. 'Total response' includes his thoughts and feelings, not merely his interpretations and behavior. Many patients, mostly psychotics or those with character disorders, cannot use transference interpretations because of an impaired sense of reality. Since they function at the level of early infancy, with primary narcissism and delusion, their needs must be met on that level. The reality of the analyst's being, his actual personality, and his spontaneous responses constitute that reality for such patients. Only through this real relationship can one 'make the patient's ego accessible to transference interpretation by breaking up a delusional transference'. Little urges experimentation with this principle, which she has found eminently successful.