Psychoanalysis has a distinctive ethical quality based on both philosophical and technical principles. The existence of the unconscious and of transference and countertransference determine the analyst's frame of reference and behavior. Working with the intense instinctual pressures of analyst and analysand can strain the limits of the clinician's skills and tolerance. The author considers issues that call most urgently for controls in the consulting room and that reveal the complexities of making clinical decisions: boundary issues; self-disclosure; case selection; transference enactment; extra-analytic contact; informed consent; and end-points of analyses. Case examples highlight some of the dilemmas analysts face when confronted with behaviors that conflict with social mores or laws. The author concludes that the analyst's choices in these difficult situations are guided by consideration of the goals of psychoanalysis and the states of both analysand and analyst with respect to the transference.