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This paper is a slightly revised version of a paper presented on 26 October 1989 as one of the Tavistock Open Lectures. The role of grandparents is discussed and the value of a supportive presence, both externally and internally, is emphasised, especially at birth and at times of mental illness. This concept is extended to the maternal or ‘grand’-maternal role adopted by agencies attempting to improve the quality of mental care, and its value is also visible in the transference in psychotherapeutic work.