I agree. I think there are much better arguments for Freud's worth (than that criticism is repetition compulsion or something), but they have been made by cultural theorists and philosophers. (I'm thinking of Laplanche, Deleuze and Guattari, Teresa DeLauretis, Spivak, etc.) In fact, contrary to Ken, I think Freud, like Nietzsche, basically drives much of US popular and political culture: it's not a question of not having thought about Freud enough. Now it's more that he pretty much thinks us. (ie We're all crypto-Freudians now.) It's one of the reasons Fred Jameson's idea of the political unconscious has been so influential--to the point that the idea is basically taken for granted.
But in a clinical setting, I just don't get how you would operationalize the interesting points of Freud's work--ie pre-Oedipal object choices, the death drive, etc. Moreover, I don't know that you'd want to, except in rare cases. (Again, it's also because they would have so little purchase in a culture in which those ideas are so constantly treated as given.) My brief encounter with contemporary psychiatry taught me, in fact, that 5 sessions with a therapist who's a good listener and a short stint on Paxil were probably a lot more helpful than drawn out analysis would have been.
Christian