Key Perspectives for Psychotherapy  Series Two

Module 4: Seeing the whole person: relational assessment, case formulation and treatment planning

What does it mean to assess a person rather than identify a problem?

 

Overview

Assessment in relational psychotherapy begins not with the client but with the therapist. Before any framework is applied, the therapist must first ask: what am I bringing to this encounter? This reflexive stance is the foundation of the workshop, which develops a comprehensive relational framework for assessment and case formulation that moves beyond symptoms and diagnoses toward an understanding of the whole person. Drawing on psychodynamic thinking, participants learn to formulate clients developmentally. Building on this, the workshop explores assessment through a mentalizing lens, drawing on Mentalization-Based Treatment, before introducing the DSM-5 Alternative Model for Personality Disorders (AMPD) as a dimensional framework that complements psychodynamic and developmental formulations.

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Learning outcomes

 

• Adopt a reflexive stance toward assessment, recognising the influence of your own assumptions and theoretical orientation

• Formulate client difficulties from a developmental and psychodynamic perspective

• Assess the influence of attachment experiences, internal object relationships, and affect regulation on current functioning

• Evaluate strengths and vulnerabilities in mentalizing capacity, emotional regulation, and reflective functioning

• Assess personality functioning using the AMPD domains of identity, self-direction, empathy, and intimacy

• Integrate psychodynamic, developmental, mentalizing, and personality-functioning perspectives into a coherent case formulation

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Module 5: When the relationship breaks: rupture, repair and the therapeutic use of failure

What does the client learn about relationship from how the therapist handles their own failures?

 

Overview

Central to this workshop is the idea that therapeutic change often depends on the therapist's willingness to bring their mind into the room. Rather than maintaining the illusion of detached neutrality, the therapist learns to use their thoughts, feelings, uncertainties, and emotional responses in the service of understanding the relationship. Drawing on contemporary relational thinking and Mentalization-Based Treatment, participants examine how moments of rupture and enactment are frequently accompanied by reductions in mentalizing. The workshop explores the relational principles of Permission, Protection, and Potency, and how thoughtful self-disclosure and the therapist's capacity to “put their mind on the table” can transform enactments into opportunities for new relational experiences.

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Learning outcomes

 

• Understand therapeutic ruptures and enactments as meaningful expressions of the client's relational world

• Recognise how the therapist's own relational patterns and script dynamics may become activated within the relationship

• Understand the concept of the Therapist's Dilemma and its role in therapeutic impasses and opportunities for change

• Recognise reductions in mentalizing during moments of relational strain

• Apply MBT principles to restore reflective functioning and facilitate collaborative meaning-making

• Use enactments and relational tensions as opportunities for creating new relational experiences

 

Module 6  Patterns that outlive their purpose: neurotic organisation and the logic of limitation

What was this person doing that made sense then - and what does it cost them now?

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Overview

This session explores neurotic organisation as the persistence of early relational solutions that have outlived their original purpose. Drawing on Fairbairn's internal saboteur and Erskine's concept of the influencing Parent ego state, the session examines how a person remains bound to an internalised relational figure whose criticism, prohibition, shame, or demand continues to organise the self from within. Personality adaptations are understood not as pathological traits but as intelligent survival strategies - the suffering preserves the attachment. The session also explores passive processes, such as discounting, grandiosity, agitation, and incapacitation, as ways the internal status quo is maintained in the therapeutic relationship. The clinical task is not to confront the pattern too quickly, but to offer a different quality of contact that recognises the survival intelligence of the adaptation.

 

Learning outcomes

 

• Understand neurotic organisation as a relational survival strategy that once protected attachment but now limits growth

• Explain Fairbairn's internal saboteur and anti-libidinal ego as attacks on hope, dependency, and relational need

• Link Fairbairn's internal saboteur with Erskine's influencing Parent ego state

• Identify passive processes such as discounting, grandiosity, agitation, and incapacitation

• Recognise why insight or premature interpretation may deepen shame and strengthen loyalty to the internal object

• Begin to formulate therapeutic stuckness as loyalty to an internalised relational figure, rather than resistance