My fundamental approach is to first explore the most concrete understanding of any clinical phenomenon. Only after this consideration of the concrete do I go on to consider metaphoric or symbolic meanings. I assume there are specific facts to be discovered about our patients and that those facts are significant in the patient’s psychology. With patients experiencing panic attacks, a detailed interview may reveal a life situation in which the patient should be afraid but does not connect the danger with the symptom. With dreams, this approach endorses a combined intersubjective and objective approach, searching for how a dream may depict a real problematic situation for the dreamer that is being dissociated. Finally, disagreeing with Greenberg and Mitchell that combined drive-relational models do not work, I propose a model of multiple drives that can each be connected with different self-states.