Conventional therapeutic psychology suggest that we are essentially self-creating and able (with a little help from a therapist) to heal ourselves of the emotional ills that beset us. This kind of view reflects the wishful thinking and make-believe that are necessary for the success of modern consumer capitalism, but it does not reflect the way things are. The alternative set out here, based on the author’s many years’ experience of practice as a clinical psychologist, offers a language and a set of concepts that enable us to understand ourselves as real, embodied beings in an equally real world that resists mere wishfulness. Our experience of ourselves, as well as much of our conduct, are accounted for in terms of the social operations of power and interest – and a framework is established for making sense of our emotional distress as the outcome of environmental pressures. David Smail argues that to take ourselves seriously as social beings, embodied in a real world over which as individuals we have very little influence, is by no means grounds for despair. Rather, it encourages modesty, appreciation of good fortune, compassion and recognition of our common humanity.