Therapeutic practice needs constant examination to ensure that it remains responsive and dynamic. Living organisms must communicate with their environment if they are to survive, and institutions are no different. This monograph, the second of the Cassell Hospital series, explores this concept further. By reading it, ideas and thinking will be sparked off that will help other organisations promote their own culture of enquiry.- Kevin Healy, Director of the Cassel Hospital, from his Foreword. The contemporary Cassel Hospital was developed by Tom Main to create a self-exploratory institution. Main argued that, in order for the hospital to be therapeutic, it needs a culture of enquiry . The individual and the institution might be seduced into ritualised working practices that no longer serve the needs of patients or staff. It is these lapses from the continual enquiry that are considered by this collection. It describes the mostly unconscious manoeuvres that inhibit reflection, and how the inappropriate use of psychoanalytic ideas can close off enquiry within a therapeutic community.