Clinicians and researchers find it difficult to adequately describe how the patient changes and what roles the clinician has in facilitating change. What approaches have been developed to help us understand how patients can expand their understanding of the source of the difficulties and what they can do to improve their lives? Dr. Gabbard will discuss some of the historical and recent efforts that have been made to understand what constitutes therapeutic action in psychoanalysis and psychoanalytic therapy. He will illustrate some of these recent advances with clinical vignettes.