Commentary on Stirling Moorey's and Janet Feigenbaum's papers

Our notions of what constitutes a good therapeutic relationship come from models developed for people with high levels of personal resources who actively choose therapy in preference to other ways of addressing their problems. The context is quite different for those with more severe and enduring mental health problems, when therapy can be one of many interventions being provided. Some of the dilemmas that arise within the therapeutic relationship in such cases can be understood in terms of the therapeutic relationship being conceived of within the dynamics of a dyad, when the actual situation is more akin to a triadic relationship comprising the client, the therapist and others involved in the client's care. Examples of threats to the therapeutic alliance, which I encounter quite frequently in my work, are explored from the perspective of the therapeutic couple within three-person space, as well as from the perspective of the differing, and sometimes conflicting, functions of mental health care. The implications of this for the provision of psychological therapy for people with severe mental health problems within the NHS are then considered.