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This paper raises and addresses issues to do with leadership and child psychotherapy, beginning with a report on a systematic review of papers about leadership in the Journal of Child Psychotherapy (JCP). The authors establish that leadership is expressed implicitly rather than as an important issue in its own right with relevance to clinical work, service development and the ongoing viability of psychoanalytic child psychotherapy. When reviewing the limited literature available, the authors classify them into five types of article: tribute to leaders past; clinical leadership; threat to survival and call to action; organisational leadership; and exemplary papers describing professional leadership. The authors query why the leadership literature is sparse and inexplicit and respond by using the theme of ‘dual citizenship’ to explore the issue from a psychoanalytic and organisational perspective. The psychoanalytic perspective explores tensions and barriers that may be profession-specific in relation to leadership. The organisational perspective explores the wider literature on leadership, starting with the concept of ‘wicked problems and clumsy solutions’. The authors introduce and describe a ‘leadership stance’ that is compatible with psychoanalytic practice in context. This requires opening up leadership activity to the same scrutiny and reflective practice as clinical work, which provides ways of containing organisational and career anxieties and perplexing clinical problems. This paper is a call to action in regard to integrating leadership into the training and the profession.