The dialectic between repetition and transformation, an inherent aspect of the therapeutic dialogue, is elaborated. Dialectic refers to an ever-present tension within a process, a pull by opposite tendencies in contradictory directions. Checks and balances between repetition and transformation are crucial. Too great a tilt toward transformation can bring the system into disorganization and instability. Too great a tilt toward repetition and the system can stagnate. The term “dialectic” is also used to refer to the tension between an emphasis on process and an emphasis on content or outcome. The massive challenges to traditional psychoanalytic treatment that stem from the empirical infant research, self psychology, general systems theory, and motivational systems are discussed. Their contributions are of particular relevance to the nonverbal dimension of the analyst—patient interaction.