A grounded theory study on the effect of the therapeutic setting on NHS psychodynamic psychotherapy from the perspective of the therapist

摘要

This study examines the effect of the therapeutic setting on the therapy from the perspective of the therapist. Six psychodynamically-trained therapists working in the NHS were interviewed. The analysis used a grounded theory based on Strauss and Corbin's (1990) methodology, although adapted to take account of Charmaz's (1990) social constructionist position. This assumes an active and non-neutral researcher shaping both the research process and product. Participants experienced the therapeutic setting as highly unstable and complicated. Internal pressures arose from difficulties around containment, anxiety, defences and management of the transference and countertransference. External pressures arose from institutional and management issues in terms of time, space, resources, power and status. Professional relationships within a multidisciplinary team could also undermine their therapeutic work. The study concludes that a psychodynamically informed reflective practice that organizes and manages aspects of the therapeutic setting over which the therapist has control will affect the therapy. Awareness of this should help the therapist to be more confident of working within less than ideal settings. Conflicts and tensions are dealt with more effectively when a therapist is confident in establishing a professional position within the NHS.