Psychoanalytic psychotherapy faces multiple challenges in the new millennium. How can it organize, teach and offer therapy in ways that are relevant to the diverse complex and social and cultural groups of people who seek psychological help? How should it adapt to demands for accountability and evidence? How can it cope in a climate of competition and market share? Should it cleave to medicine or abandon it? Define itself as a science or an art or an ethical practice? This wide-ranging work takes up some of the pressing cultural, political, organizational and ethical issues for psychoanalytic psychotherapy, placing them firmly in a clinical context. The contributors examine a range of issues from the experiences of a particular group of people in therapy (children, immigrants, gay men, short-term clients), who may challenge psychoanalytic assumptions, to the difficulties psychoanalytic psychotherapy has in organizing itself creatively in a risk-averse culture, and to the openings and connections with other disciplines that may extend and enliven critical work. The contributors write from the critical edge of psychotherapy and offer their own challenges to the profession.