This chapter attempts a systematic theoretical and clinical study of the sexuality of psychotic patients in psychiatric institutions, in particular in those the stated objective and vision of which is to create an alternative therapeutic culture and practice. It examines the determining role and the various aspects of sexuality in the field of psychotic disorders, with particular emphasis on highlighting the role of the therapeutic team and countertransference work in psychiatric institutions, with respect to better understanding and managing the expression of sexuality of patients. This debate is highlighted through the clinical material content from a psychosocial rehabilitation unit. Commitment to thinking and hoping is a strong protection of therapeutic teams against the anxiety related to the breakdown of institutions as well as their psychosis generating and neo-institutional functioning.