Patients and staff both need defenses against psychic pain. However, these defenses can become unproductive when they interfere with opportunities for psychic development and growth. It is hard being with patients whose minds may be fragmented and their lives damaged by their mental illness. This can be as difficult for staff to face as it is for patients. Staff need to be helped to notice when they turn away from painful thought about their patients to idealized solutions like medication. Supervision groups can help support staff's curiosity and interest in their patients even when they are very ill or their behaviour is challenging.

Psychoanalytic supervision can help staff tune into the psychotic level of communication in both psychotic and personality disordered patients. While patients need their psychotic defences from time to time, they also fear being left on their own with their psychosis. The patient needs to feel staff understand that while they are unable to face the pain and damage done to their lives through illness, they can rely on staff to support them in their fight to remain in touch with reality. Psychoanalysis offers a model for thinking about, and providing meaning for, the anxieties that drive us “out of our minds,” and this can reduce the risk of thoughtless action.