The practicing clinician is faced with the tension between purism and pragmatism. Purist approaches have a unitary clinical style that is integrated with a theory of human nature and development. Pragmatism is the belief that no map matches the territory, and that it is dangerous to sacrifice the patient's interests on the altar of unified conceptions.

Psychoanalysis has been dominated by purist voices, and this paper presents a perspective, Critical Pluralism, which allows using these voices without losing touch with pragmatist ethics. I assume that clinical practice is governed by mutually exclusive ideals and values represented by the various purist approaches. The individual clinician creates his or her therapeutic voice by living in the cultural space created by purist voices and the tension between purism and pragmatism. It is shown that this metatheoretical position has clinical implications and advantages.