Sunday, December 20, 2020

Towards a definition of relational psychiatry

Having renamed this blog 'relational psychiatry' (see previous post), I probably should make more of an attempt to define relational psychiatry. As Richard Gipps says (see last post), the term "doesn't yet have an established use".

Relational psychiatry takes an anti-mechanistic approach to life, including human life. Despite its attractions from Descartes onwards (see eg. previous post), a mechanistic conception of nature fails to provide a complete characterisation of living systems (see eg. another previous post). Medical psychology therefore needs to take a pragmatic anthropological approach as a mechanistic psychology is impossible to realise in practice. It needs to focus on the person-environment interaction.

The implications are that there is nothing else apart from the therapeutic relationship, both individual and group, in psychiatric treatment (although I agree with Richard that this position forms part of the definition of relational psychiatry, as it doesn't' necessarily follow from what I am saying about mechanistic psychology). I also agree with Richard that actual clinical practice is not necessarily the same as theoretical practice. Relational psychiatry does need to actually make psychiatry more relational. This means that practice needs to be truly person-centred (see eg. previous post). As Richard points out, the current Royal College of Psychiatrists' curriculum doesn't even make this clear. 

1 comment:

Unknown said...

Thank you for renaming your blog. I may not have found it otherwise. I Googled “relational psychiatry” because it is an idea that has been percolating in my brain for quite some time.

I’m a community mental health psychiatrist in the U.S. Many of my patients are referred to me because of a belief that pharmacologic interventions will be beneficial. As you know, medications can sometimes be helpful but oftentimes are not. Therefore, understanding a patient's relationship to medications is a priority for me - especially during the initial appointments.

I agree that relational psychiatry should actually make psychiatry more relational. I have found it helpful to share with my community mental health team members - which include psychotherapists and general practitioners among others - my clinical impressions about a particular patient’s relationship to medications (and other external factors). This encourages a discussion about other relationships that are a source of suffering for our patients.

Viewing our patients’ various sources of distress through the lens of relationships helps us tailor treatments specifically for them - a goal of patient-centered care. As Richard Gipps points out, the term relational psychiatry "doesn't yet have an established use,” but my colleagues have been very open minded and accepting of these ideas.

Thank you for maintaining your blog about relational psychiatry. I’m looking forward to learning more.