Conducting psychotherapy in a residential institution introduces complications not usually encountered in out-patient work. A description is given of the institution, of the position of the therapist who also had other roles in the institution, and of the patient, a girl of 11 years old with a diagnosis of childhood psychosis. Complications which arose for both patient and therapist in relation to each other and the institution, and their responses to these are described.

It is concluded that it was possible to develop and maintain the relationship necessary for psychoanalytic psychotherapy in a residential institution where both parties had relationships with other staff and children. It creates problems which require new responses to be developed by patient and therapist. The position of the psychotherapy in the overall treatment of the child is discussed and it is suggested that sharing more information with other staff than is usual in psychotherapy can be beneficial for the child.