American psychoanalysis is in a state of crisis, manifold though largely unrecognized: its theoretical underpinnings either dead (metapsychology) or in poor shape (clinical theory), its status as a science under severe attack, research, though promising, is proceeding very slowly, the therapy's efficacy is being challenged by competing schools. Some ways in which the theory has negative effects on clinical work are pointed out. The psychoanalytic movement has become a conservative establishment resisting change, educationally stagnant, and organizationally undemocratic; it also faces a moral crisis. Some suggestions are offered for the fundamental reform and reconstruction that is needed so that the unique contribution of psychoanalysis to human welfare, science, and culture not be lost.