Rudi Vermote explains how he became interested in W. R. Bion’s later work and discusses some of the reasons for the relative lack of attention to Bion’s later writings. He discusses his understanding of the implications of Bion’s shift from emphasizing transformations in knowledge to focusing on what he described as transformations in O. He considers some related psychoanalytic concepts and reflects on the implications of the development in Bion’s thinking for clinical practice.