This introduction presents the context and background of the case presentation and commentary. Katherine (Kate) Oram's beautifully presented study and the commentaries from four different points of view raise issues and questions that are central to contemporary psychoanalytic theory and practice. Among these topics are the following: the relation between verbal and nonverbal aspects of treatment, technical considerations in the analyst's sharing personal reactions and feelings, the role of deficit versus conflict in the treatment of a traumatized patient, clinical aspects of termination and especially of posttermination contact, the place of siblings in the patient's family dynamics, the applicability of attachment theory to in depth psychoanalytic practice, the handling of sadomasochistic dynamics in the analytic interaction, and the role of mutual gift-giving between patient and analyst during the course of an analysis.