Melanie Klein's differentiation of two basic groupings of anxieties and defences, the paranoid-schizoid and depressive positions, is one of her important contributions to psychoanalysis. This chapter describes what she meant by these terms and in the process. It illustrates how useful they can be when people try to orientate themselves towards their patients in a clinical setting. The chapter suggests that more recent work enables people to refine these concepts and to subdivide each of the positions to produce a more detailed developmental continuum which retains the dynamic notion of an equilibrium. In the paranoid-schizoid position anxieties of a primitive nature threaten the immature ego and lead to the mobilization of primitive defences. The chapter presents some clinical fragments, from a consultation interview with a patient operating chiefly at a paranoid-schizoid level. The depressive position represents an important developmental advance in which whole objects begin to be recognized and ambivalent impulses become directed towards the primary object.