In the former Czechoslovakia psychoanalysis was practiced since the thirties without interruption until the present time. It survived forty years under the Communist regime in underground conditions. The author describes the specific and historical features of the Czech underground and its tradition in Czech culture. Specific parameters of psychoanalytic treatment under unfavorable and dangerous social conditions are demonstrated. Issues of transference and countertransference problems are discussed. The psychoanalytic theory of reality, its levels, and “compartments” help in understanding how the safe space in the psychoanalytic process could be created and maintained. The special ethical role of psychoanalysts in totalitarian society is underlined. Clinical vignettes are used to illustrate problems of the underground psychoanalytic practice.