The future of analytic child and adolescent therapy is uncertain. It is difficult to know what shape it will take in the next 20 to 30 years. I am aware how much it has changed since I began working in this way in 1971. Both theory and techniques have changed. There has been a gradual but definite shift away from the importance of insight and interpretation to a stronger acknowledgment of the therapeutic relationship. The impact of a faster, more technological world, the role of psychiatric medication, ever-increasing neurological knowledge, growing research literature on infantile development, and the heightened awareness of systemic forces within the family, all combine to challenge the role of the analytic child therapist. The position of child psychoanalysis is now seriously threatened. The world demands quicker and less intensive methods. Child therapists must recognise that the model of seeing a child four or five times a week is becoming increasingly unrealistic. Even seeing a child once a week over any length of time is becoming a battle. This depressing view of analytic child therapy is counterbalanced by the excitement of new ways of working.