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In discussing “Synchronicity, Acausal Connection, and the Fractal Dynamics of Clinical Practice” (this issue), a post-Bionian perspective is used to draw out some of the similarities, differences, and implications of a fractal epistemology. In particular, Bion’s concept of O, his theory of transformation, and his clinical approach, are considered in exploring the idea of a “primary substrate,” nonlocal information sharing and synchronicity. Using a brief case vignette, and drawing on clinical examples in the paper, the clinical implications of the authors’ metatheory are considered.