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The collective assessment of INSERM (French Institute of Health and Medical Research) on the various types of psychotherapy fits into a general scientific context, a specific health and professional policy. The approach eventually adopted (evidence-based medicine), on the basis of certain methodological criteria, privileges ad hoc studies centered on reducing symptoms and isolated disorders, or simple acquisitions. This choice has been made to the detriment of studies relating to the mental functioning and development of the person in the context of complex pathologies, as well as those relating to processes of change. The first consequence of the assessment was rampant communication from the “winners” on the basis of an unwarranted generalization of partial results. But things are not that simple. Analysis of the results of psychoanalytical therapies highlights very clearly the very small number of studies that meet the “gold standard” for current methodologies. But we also need to consider their useful aspects: high clinical representativeness, presentation and involvement of theoretical models in implementation and judgement criteria, combined definition of objectives and special technical aspects, and the implementation of appropriate instruments. These special features, backed up by fifty years of research by highly motivated teams (especially in the field of borderline personality disorders) herald a shift in clinical research in psychoanalysis. This will concern the approaches and special procedures for intervention during the various stages of psychotherapy, adapted to psychopathological observations and the specific objectives they determine. This shift will be centered on processes of change in a configuration involving not only pathology, but also health and the various players taking part in it. This alternative view of evaluation, which is extremely close to natural conditions, is largely called for. It complements rather than takes the place of controlled experimental studies, and its expected advantages (both in terms of general knowledge and in usefulness for patients, clinicians, and health decision makers) are powerful reasons for its development.