Institutions represent both the conscious and unconscious aspects of the interacting members. Psychotherapists need to address their unconscious position in the institution as well as the conscious aspects of their work. This paper describes the possible relevance that psychotherapy may have at the unconscious level. The notion of the ‘social defence system’ is extremely useful in finding one's way in the engulfing emotional attitudes, and for tolerating the often dismaying sense of irrelevance that psychotherapy appears to attract. The social defence system of a prison and a mental hospital are considered in this light and some thoughts are devoted to the changing state of the National Health Service at present.