This paper is based on an invited contribution to the first APP conference on psychoanalytic psychotherapy services in Europe. I was asked to address the question “How can psychotherapists influence psychiatry?” within the overall title for the half-day session of “Psychiatry and Psychodynamics: Towards integration or splitting”. As a background to later discussion I began with a historical sketch of how we had arrived at the current situation in the UK with a specialty of psychotherapy, both separate from and yet still within psychiatry. I argued the need for a separate specialty to protect the space needed for psychotherapy in the face of the inevitable polarisations that occur within psychiatry. Some of the tensions between the different points of view are likened to those between masculine and feminine roles. This specialty might eventually emerge into or foster a new profession of psychotherapy but will still need to negotiate its position in relation to psychiatry.