This paper illustrates the value of the individual analyst's deep knowledge of the patient in a couple setting; describes how the analyst informed by many theoretical perspectives decided to work in different modalities (individual, group, couple) with the same patient; and discusses when such additions would have been contraindicated as well as what could have been the consequences if the analyst did not attune to the patient's need for “optimum space” or follow the direction of the patient's creative gestures.