This paper describes how the nursing staff of a specialist psychiatric service used psychoanalytic thinking in a weekly staff support group to reflect on a structural change to the service and on clinical practice. This enabled the nurses to discover a system of defences, partly reflecting that of the patient group, from anxieties relating to the care of challenging and seriously ill patients.

It is suggested that the systematic use of psychoanalytic thinking for the support, training and supervision of staff makes a valuable contribution to the development and maintenance of safe practice with a view to meeting the Department of Health guidelines for clinical governance to improve quality of service, safeguard standards of practice and create an environment in which a high level of clinical care can be achieved and maintained.