Practitioners interested in the process of helping people change are confronted today with such a burgeoning array of perspectives, theories, and treatment modalities that even the most diligent can feel overwhelmed by the number of choices. This plethora of approaches calls into question whether there is anything that can tie them together. Asking if the psychoanalytic field is destined to be splintered into fragments that defy cohesion or if it is possible to generate a way of thinking and working that is more inclusive, this paper takes a historical and integrationist approach, grounded in a clinical focus on mental organization and Leo Rangell’s total composite theory. It discusses trends in the development of psychoanalysis and argues for the importance of integration of the findings from neuropsychology and neuropsychoanalysis into psychoanalytic clinical work.