The investigation of psychopathology and the development of personality have traditionally been carried out by two different methods. Psychoanalytic theory has largely relied on the hermeneutic approach, that is the explication of meanings. This has yielded rich and clinically relevant insights into individual functioning, but has the danger of conflating meaning with causes. The empirical approach, the dominant method of science, has in recent years begun to establish aetiological factors for mental ill-health. In the clinical situation, these findings have to be applied with caution as one can only rarely determine with a particular individual how important they are. At the same time, these findings establish important parameters in understanding and treating patients. This paper argues that, for the effective practice of psychoanalytic psychotherapy, the therapist should both be conversant with these two models and be able to integrate them.