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In this article, the author synthesizes the discussions brought up during the conference “Therapeutic Mediations in Institutional Practice” and offers several perspectives to clinicians who wish to set up, in their everyday practice, this particular device. He stresses how, up until now, the literature and institutional testimonies of therapeutic mediations have at times left practitioners quite confused when trying to aim towards metapsychology. He reminds us how, over the past ten years, the work of Lyon University and researchers such as B. Chouvier, R. Roussillon, and A. Brun have reinvigorated theoretical and clinical perspectives regarding the design and animation of psychoanalytical devices for therapeutic mediation. Among the various devices deployed in relation to a psychoanalytic trend that operates without the use of couches, therapeutic mediations are now at the forefront after having, for a long time, been considered as the poor relative of clinical practice.