Objective The aim is to identify and illustrate the place of psychodynamic practice and the therapeutic relationship in psychiatry, including consideration of the need for psychodynamic formulation and longer-term psychotherapies, in the context of debate over guidelines for depression management. Conclusions Effective psychiatric practice requires a working understanding of psychodynamic principles. Effective management planning is underpinned by psychodynamic formulation. A full range of therapeutic options need to be available for optimal care.