In this paper I discuss the diminishing role played by psychoanalytic/psychodynamic psychotherapy in public sector mental health treatment services and explore the impact of this on the psychoanalytic profession and its trainees. I draw on the discipline of pragmatics to argue that we need to move from a theory-based approach to clinical practice to a research-based model in which we draw on an integration of evidence from a range of disciplines to build an understanding of the developmental and neuroscientific basis of psychological and emotional problems, with a particular focus on complex PTSD and its overlap with borderline personality disorder. I discuss how process research and outcome studies provide additional tools to add to our understanding of the clinical interaction in the consulting room. I discuss the implications of these findings for clinical practice and the need for clinicians to begin to integrate research into their training and professional development.