Consulting to Chaos: An Approach to Patient-Centred Reflective Practice

Editor : John Gordon, Editor : Gabriel Kirtchuk, Editor : Maggie McAlister, Editor : David Reiss

Consulting to Chaos: An Approach to Patient-Centred Reflective Practice

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In clinical work, an awareness of patients’ subjective experiences, particularly their perceptions of interpersonal relationships, is indispensable. The aim of this book is to improve care and treatment planning by describing a structured approach to eliciting patients’ core relationship patterns. These patterns consist of the roles and scenarios into which they repeatedly cast themselves and others with whom they interact. Maladaptive patterns, in which vicious cycles and self-fulfilling prophecies of misperception, misunderstanding or provocation escalate, cause pain and havoc in personal relationships and can adversely affect both professionals’ decisions and the overall delivery of treatment. This book shows how to use vital information that is often not made available to treatment teams in order to understand such potential pitfalls rather than succumb to them.

Reviews and Endorsements

‘Implicitly, this book draws our attention to a correlation between the mental health of the professional team and the quality of the intervention they are able to provide. It highlights the extent to which disturbance in the patient can and does become projected into and identified with by the staff and by the system that provide their care. Simply put, this book describes a method of organisational consultation that seeks to transform the enactments that flow from being fearful of, angry with, or despairing about the patient into attending to and thinking about the patient.’
—Julian Lousada, Vice Chair, British Psychotherapy Foundation; from the Foreword

‘This book is a must-read for any person working in forensic psychiatry settings. The method described provides immunisation against the “contagiousness” of certain mental disorders by helping elucidate staff responses and then unifying clinical teams’ care of patients. It’s a win–win for patients and staff and, therefore, for everyone.’
—Carine Minne, Consultant Psychiatrist in Forensic Psychotherapy, Broadmoor Hospital

‘In a “one-stop shop” volume, John Gordon and Gabriel Kirtchuk have, uniquely, furnished the mental health practitioner community and others working with suffering and violence in institutional settings with an innovative approach. Understanding the Interpersonal Dynamic consultation is central to the book and, moreover, the very application to a broad range of significant psychopathology is highlighted by the careful and considered use of appropriate case material. Not only do the authors present a conceptualisation of treatment intervention based on a comprehensive and systematic assessment architecture, but their account also emphasises, in stark contrast to more traditional psychotherapeutic practice, the notion of inclusivity and accessibility.’
— Colin R. Martin, Professor of Mental Health, Buckinghamshire New University; from the Afterword

About the Editor(s)

John Gordon is a Founder Member of the British Psychoanalytic Association and Senior Member of both the British Psychotherapy Foundation and the Institute of Group Analysis. Previously he was Consultant Adult Psychotherapist in a Forensic Psychotherapy Department and at the Cassel Hospital. He is Senior Lecturer at Buckinghamshire New University where, in collaboration with West London Mental Health NHS Trust, he co-organises, teaches and facilitates an experiential group on an MSc in Psychodynamic Approaches in Mental Health. He is co-author with the late Stuart Whiteley of Group Approaches in Psychiatry (1979), co-editor of Psychic Assaults: Countertransference in Forensic Settings (2008) and co-author of Interpersonal Dynamics Consultation: A Manual for Clinicians (2013). He has published many papers on the development of Bion’s thinking on psychosis and its application to clinical work with individuals, groups and organisations. He currently practices privately as a psychoanalyst and supervisor.

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Professor Gabriel Kirtchuk is a Consultant Psychiatrist in Psychotherapy (Forensic) and a Fellow of the British Psychoanalytical Society. He is the Head of the Forensic Psychotherapy Department at West London Mental Health NHS Trust where, in collaboration with Buckinghamshire New University, he developed and is co-leader of an MSc in Psychotherapeutic Approaches in Mental Health. He and his colleagues have developed over the years a manual which facilitates the systematic study of transference/counter-transference patterns by means of consultations with multi-disciplinary teams, particularly in in-patient forensic settings; more recently this approach has been extended to services in the community as well as generic psychiatric, child and adolescent settings. Until recently he was Lead Clinician of the National Forensic Psychotherapy Training and Development Strategy, a post he held for many years. He is an Honorary Senior Lecturer at Imperial College Medical School and Chair of the Forensic Psychotherapy Society, a Member Institution of the BPC.

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Maggie McAlister is a member of the Society of Analytical Psychology and works as a Principle Adult Psychotherapist in a Forensic Psychotherapy department in a medium secure unit in the NHS. She originally worked as a Dramatherapist in adult mental health settings and has written and published extensively on her work as an Arts Psychotherapist and Adult Analyst in forensic and adult psychiatry. She is a registered supervisor and senior lecturer for the MSc in Psychotherapeutic Approaches to Mental Health jointly run by West London Mental Health Trust and Buckinghamshire New University. She has a private practice in North London.

David Reiss, MA, MBBChir, MPhil, PgD, FRCPsych, FAcadMEd, is a Consultant Forensic Psychiatrist, West London Mental Health NHS Trust and Honorary Clinical Senior Lecturer, Imperial College London. His research interests are in the interface between clinical forensic psychiatry and public policy, including work on personality disorder, recidivism, homicide inquiries and educational issues. His clinical and educational work focuses on enabling the multidisciplinary team to gain an enhanced understanding of patients, thereby improving care and reducing risk.

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