This paper offers a series of reflections on 50 years of experience as a psychotherapist. The topics covered include recollections of working with the most severe psychological disturbances, the risks and rewards of clinical practice, the indispensable importance to the clinician of self knowledge, and the ways that psychotherapy transforms not only the patient but also the therapist. The most significant future directions of work in the field of psychoanalytic psychotherapy are also discussed.