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This paper encourages clinicians to consider how patients’ conflicts and symptoms reveal not only familial etiology but the internalization of hegemonic structures and ideology. It explores how the subject evolves within the cultural matrix of neoliberalism, the contemporary hegemonic system that shapes unconscious fantasy, conflicts and defenses. Several clinical case vignettes illustrate the benefits to both analyst and patient of exploring within the transference and countertransference how neoliberal hierarchical arrangements of class, race and gender affect subjective and intersubjective experience.