The purpose of this paper is to relate traditional psychoanalytic ideas on aims and outcomes to the changing world of contemporary psychoanalytic psychotherapy, with its financial constraints and theoretical and technical innovations. An emphasis on splitting rather than repression, on the nature of the attachment between therapist and patient, and on realistic goals and modest change all characterise contemporary perspectives. Recent developments in the cognitive behavioural psychotherapy literature indicate possible areas of overlap with psychoanalytic psychotherapy. Attachment theory proposes that patient-therapist attunement is likely to be a key variable in outcome. Since attunement is intrinsically responsive rather than directive, the paradox of psychoanalytic ‘aimlessness’ is inherent in the nature of psychoanalytic psychotherapy.