Over the last century there have been significant changes in understanding the mind and brain: both in psychiatric practice; and in psychotherapeutic practice. In psychodynamic thought the central change is a theoretical shift away from drive theory, with its intra-psychic focus, towards relational theory, with an intersubjective focus. The recognition of the role of relational trauma as a common basis for mental suffering confronts us with a communal responsibility to provide adequate therapeutic responses. In this talk some of the key points in the evolution of psychodynamic theory are highlighted, particularly seeking to identify points of practical application to current psychotherapeutic practice. In addition some of the research by the Westmead Psychotherapy Program is highlighted with respect to contributions to outcome, phenomenological, and process research.
Some findings point towards paradoxes in clinical presentations: for instance, people who present with self-harm often demonstrate marked “harm avoidance” as a temperamental characteristic; another study demonstrates a form of physiological dissociation in BPD that may account for some of its features. We have been one of few groups to demonstrate additional benefit in treatment when patients stay in therapy for a second year. A range of responses, including the Conversational Model at Westmead, and others such as Dialectical Behaviour Therapy and Metallisation Based Therapy have been applied to public sector services. This talk will look at the characteristics of these programs with a view to promoting a discussion on optimising psychotherapeutic treatment for clients presenting to public health settings.
