The psychoanalytic exchange is a highly complex, nuanced, and difficult to master process. This paper employs Lichtenberg’s formulation of a personal sense of power to address often befuddling exchanges that can occur between analyst and difficult-to-treat patients. A sense of power provides self-regulatory as well as interactive regulatory functions for each participant. One’s sense of agency lies at the heart of such a sense of power. Recognizing fluctuations in the analyst’s sense of power and in the patient’s sense of power can inform the treatment situation. I demonstrate how these formulations can suggest a more impactful, therapeutic, affective engagement between analyst and patient. Several clinical examples explore how challenging therapeutic situations such as eruptive aggression, entrenched depression, racism, and misogyny can be approached in new ways. The elaborated approach can facilitate significant transformations for patients, and a greater sense of competence and satisfaction for the treating analyst.