This chapter focuses on the organizational settings in which professionals concerned with supporting children, parents and families ®nd themselves, and to which they are accountable. The organizational setting is one of signi®cant power and in¯uence, and shapes the way in which assessment and therapeutic communication is carried out with all clients and patients. The organizational setting also has an impact on professionals in terms of promoting or undermining their skills, their health and their wellbeing. This chapter will demonstrate, therefore, that in order to be effective, an organization concerned with child and family mental health must carry out a process of assessment on itself, and evaluate its capacity to promote a therapeutic environment to ful®l its primary task of supporting children, parents and families. The organizational theorist Harold Bridger (1990) has called this process `the double task'. Bridger puts forward the view that all organizations, not just those associated with the helping professions, are faced with two tasks; one is to carry out their work, and the other is to take time out to review their work. The process of review is essential to assessing the continued relevance of the task, to assessing what changes need to take place and, above all, to give those involved a sense that their concerns can be both aired and responded to. Regrettably, carrying out this task of organizational self-examination tends to be a rare occurrence. It must also be pointed out that the dynamic process of organizational selfassessment bears no relation to current managerial directives with respect to identifying output, throughput and benchmarks. In the absence of a sense of organizational awareness, many professionals ®nd themselves concentrating on their individual work with clients or patients whilst attempting to ignore the `noise' of the organization, or in some cases trying to work around the organization or to mitigate what they may perceive as the negative impact of the organization on their clients, their patients and themselves.