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Dr. Melandri’s use of the 2001 Revised Diagnostic Profile to assess 5-year-old Leo brought forth different emphases than Anna Freud’s original Diagnostic Profile (1965). Dr. Melandri’s explicit sharing of how she reacted to and felt in Leo’s presence is far more explicit. Another difference is how fluently Dr. Melandri integrates metapsychology with diverse clinical theories to describe Leo’s development. Had the original Diagnostic Profile been used, there would have been greater emphasis on libidinal phase development, such as orality, anality, phallic, and oedipal development, not to mention dynamic and structural achievements. This essay asks: “what’s at stake?” regarding these different emphases. The author concludes with a few remarks in general about the 2001 Revised Profile, including comments about the fate of Freud’s and Anna Freud’s radical vision.