Judy Pickles's case presents a radical model for psychoanalytic treatment that has been evolving for several years. It is a systems theory model, a bidirectional model of interactions through which new patterns emerge. Primacy is accorded to the patterns of interaction between therapist and patient, the intertwining of verbal with nonverbal modes, and the assumption that growth, change, transformation, and development can take place implicitly, without necessarily having to be verbalized or analyzed. The treatment of Ann required parameters of a magnitude unimagined by Freud or Kohut—support, suggestion, inspiration, reassurance, telephone contacts, letters, photos, and of course, the discussion of presenting this case at this conference. Judy Pickles illustrates that the process of therapist and patient fitting together is both the medium and the message.