Evidence-based medicine requires clinicians to base treatment of their patients on the findings of systematic clinical research. In recent years EBM has become linked with appropriate but also inappropriate efforts at cost containment. Organized psychiatry responded by developing evidence-based practice guidelines and launching a range of clinical research initiatives to determine the effectiveness and efficacy of current psychiatric practices. Psychoanalysis is particularly challenged because it has for most of the 20th century been based on conviction alone. Investigators have now identified the obstacles to research into psychoanalysis and dynamic psychotherapy and are developing techniques to overcome these and to study not only outcomes but also the internal processes of these treatment modalities. We may look forward to an evidence-based psychoanalysis in the 21st century.