At first sight, a psychoanalytic perspective on clinical work may seem to some to have nothing to offer the old age psychiatrist and his team. However, psychiatrists’ daily work involves unconscious as well as conscious phenomena. In this paper the present value and future possibilities of a psychoanalytic understanding are emphasised, both in terms of therapy for individual patients and also to inform other work within the department. Clinical material is introduced to illustrate these ideas. It is suggested that psychoanalytic psychotherapy is used not to replace other treatments, but as an adjunct to biological, social and other psychological approaches, to the benefit of individual patients, staff, and the service itself.