The major figures in the theory and practice of psychoanalysis and psychotherapy, with some exceptions, paid scant attention to concepts of power. In a more democratic age, the assumed power differential between the authoritative therapist and the suppliant patient is often scrutinised. This scrutiny may be clinical or variously politicised. Vigorous opposition to this model emphasises the generally underestimated power of the patient. Yet the meanings of the word “power,” as comprehensive concept, process and experience, are likely to be unexamined. Some question whether the word can be used to clearly describe anything at all in psychotherapy. However, it is argued that an examination of this universalising concept of power and its intensities, may provide another perspective on the therapeutic conversation.
Attachment theory is a robust biopsychosocial model that is developmental and evolutionary based, proposing that human beings develop in relationship. It speaks to both the development of self and self-regulation and the mal/adaptations and disruptions due to stress or trauma that often underlie health presentations as well as the ongoing power of relationships to promote resilience and to heal. It powerfully predicts the stress responses and the coping strategies that arise if a person is not safely and comfortably supported, including both the conscious strategies and unconscious strategies. It then offers a guide to different recovery pathways and strategies and is a model that can apply to systems and cultures as well as the individual and is conducive to integrated care. An overview of a body of collaborative biopsychosocial research (including work by McLean, Kozlowska and Proctor) will be presented, using the unifying model of Attachment theory for research and integrated care.
This paper will give an overview of the research efforts conducted by the Westmead Psychotherapy Research Program over the last 25 years. Examples are given of research that relates to outcome, phenomenology and process in the treatment of Borderline Personality Disorder. The basis of research in psychotherapy is also discussed with reference to the need to continue questioning our philosophical assumptions.
STIPP has a history that goes back to the 1950’s – pioneers were Luborsky, Malan, Basch, Abbass and others. I will give a brief overview of a model of STIPP which was the outcome of my attendance at short term therapy training workshops overseas and the use of important principles of the Conversational Model derived from my training. I developed this way of working over many years in my private practice with adolescents and adults. It is being taught as a 28 week part time short course at the psychotherapy training unit since 2011. STIPP is recommended for a wide variety of patients seen in day to day clinical work, so long as they meet the assessment criteria which I will outline. A history of trauma is not an exclusion factor.
Severe trauma in both children and adults leads to a disintegration of the core aspects of self-organisation and experience. In treating clients who are survivors of loss, trauma and torture, we need to optimize their assessment, case formulation and treatment plan to promote biopsychosocial recovery.
When we think about “ethics” or “ethical practice” our minds can move in two main directions: that this relates to serious transgressions (which does not involve us) or that this is something to do with our professional codes (which we will read if and when required). In fact, our need to respond ethically occurs in a myriad of small ways that make up the moment to moment relational transactions through which we deliver our services. This should mean that discussions about ethics are commonplace with colleagues, and yet they are often not.