Completion of the dissertation is an important milestone and often a major obstacle for PhD candidates, some of whom become and remain all-but-the-dissertation students. All-but-the-dissertation students usually disappoint both themselves and their departments. Thus it is important to understand the psychology of the dissertation. A review of doctoral dissertations on the topic of dissertation completion is followed by a discussion of developmental conflicts that frequently influence dissertation difficulties and then a presentation of the dynamic psychotherapy of a patient struggling to complete a dissertation. Problems in both external reality and internal fantasy are noted. The importance of understanding specific developmental conflicts and individual dynamics in treatment of this population is emphasized.