In recent papers there has been considerable interest in the disclosure of the analyst's erotic countertransference. In our view this discussion touches a more fundamental issue: must something “real” take place between analyst and patient in order for real change to occur? And if what takes place is “real,” will it not be dangerous and potentially destructive? Tracing the history of psychoanalytic understandings of what is “real” in the patient's life and what is “real” in the transference, we explore these questions in a clinical vignette and discuss the implications of this issue for our understanding of the process of psychoanalytic treatment.