In this article, we describe the development of the Comparative Outcomes in Psychotherapy and Psychoanalysis Study (COPPS). COPPS is planned to be a multisite outcome and process study of psychoanalysis that incorporates methodology that is now standard for clinical trials and particularly psychotherapy studies. We begin with an overview of the process of protocol development and key methodological issues. Next, we describe a completed pilot study that establishes the feasibility of randomizing patients to analysis. We then discuss what is needed to execute the study and the potential impact on and value for the field.