The intellectual, social, and professional contexts in which Freud developed his ideas about psychotherapy are discussed, reviewing the different models (topographic, economic, dynamic, and genetic) subsumed under his early drive‐conflict theory. The development of his later structural (id, ego, superego) model and the emphasis on defense and adaptation characteristic of the ego psychology tradition that derived from that paradigm are then addressed. British object relations and American interpersonal theories, the self‐psychology movement, and contemporary intersubjective and relational contributions to the psychoanalytic clinical literature are reviewed. In each section, both the context in which innovative theoretical contributions arose (especially the type of patient with whom the theorist worked) and the implications of the different paradigms for psychotherapy are addressed. Research is examined that is pertinent to the ingredients of the psychodynamic therapies as they have been empirically found to be practiced, covering studies of affective expression, attention to defense, identification of patient problems, interest in effects of past experiences, focus on interpersonal experiences, emphasis on the therapeutic relationship (the therapeutic alliance and transference), and exploration of dreams, wishes, and fantasies. Finally, outcome studies in psychoanalysis and long‐term psychodynamic therapy are reviewed and recommendations for further research are made.