Psychoanalysis is hardly a practical treatment alternative for the twenty-first century. However, the principles derived from this treatment have powerfully influenced other psychotherapeutic approaches, whether long-term or short-term therapy or psychiatric care more generally, particularly in the United States. At the time of its invention, it was the unique effective psychosocial treatment method for psychiatric disorder which offered a genuine alternative to the sometimes barbaric and generally ineffective treatment methods available. Not surprisingly, its proponents adopted an almost religious zeal in defending its value against alternative approaches. While understandable, such an attitude has no place in the sophisticated evidence base underpinning multiagency service planning. Psychoanalytic clinicians face a challenge in identifying their niche in the complex mental health care delivery systems of the twenty-first century.

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