Major points of three reviews—by Malcolm Owen Slavin, Ruth Stein, and Donnel Stern—are highlighted and further elaborated, particularly the broad existential foundations of dialectical constructivism, the importance of dialectical thinking, and the centrality of the struggle with epistemological and moral uncertainty in this perspective. Several counterpoints are formulated—for example, the seemingly paradoxical commitment to a definitive theory of the process, the place of objective facts and universal principles in experience that is fundamentally ambiguous, and the pragmatic necessity for commitment to particular understandings and courses of action in the light of the passage of time and of mortality. Some clinical examples are presented to illustrate the dialectic of ritual and spontaneity as reflected in the tailoring of the frame to suit particular analytic relationships. Precursors of dialectical constructivism in the author's early work are identified.