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Alongside concerted political action, the survival of psychoanalytic psychotherapy in the NHS will require adaptation within the psychoanalytic community. This paper looks at the difficulties facing the profession, provides an example of the important role the profession can play in the NHS, and then outlines three areas for examination and adaptation in order to enable survival and development: professional narcissism of minor difference, the use of language, and a broader understanding of ‘risk’ in mental health services.