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Based on the author's clinical experience as psychoanalytic psychotherapists, this reconsideration of lesbian lives and lesbian experiences offers a new and thoughtful framework that does not inevitably pathologize or universalize all lesbianism, but instead argues for the development of a psychotherapeutic theory and practice open to the complexities and vicissitudes of individual life histories, relationships, and identities. Surveying a wide range of psychoanalytic ideas about lesbianism, O'Connor and Ryan critically address questions of sexual identity, sexual desire, and gender identity, of transference and countertransference, and also of institutional practices in relation to psychoanalytic training.