This paper considers implications to psychoanalytic psychotherapy of the British Government's decision to implement a patient choice agenda for state-funded mental health services in England and Wales. It places the patient choice agenda in the context of consumerist society and argues that the complex nature of psychoanalytic psychotherapy leaves it more vulnerable than other psychological therapy modalities to compete in the current reality of ‘consumer’-led public mental health, which, in turn reflects a profoundly changed social context from that to which psychoanalysis traces its roots. Unless psychoanalytic clinicians recognize and find ways to adjust to this context they will jeopardize the survival of psychoanalytic psychotherapy in an increasingly market-orientated model of mental healthcare provision in the public sector, eager to promote more ‘consumer friendly’ psychological therapy models.