ABSTRACT

The concept of a therapeutic ecosystem is identified, a phrase derived from ecology and applied metaphorically to those conditions which allow for the development of a productive alliance between client and psychotherapist. The factors which seem to support the therapeutic alliance and those which seem to prevent it are discussed, and the fact that psychotherapy may not be the right choice for everyone. The concept of client agency, responsibility and choice is discussed with reference to the work of Lomas. A distinction is drawn between counselling and psychotherapy with reference to the work of Winnicott, Kohut and Kernberg. Therapeutic resistance is discussed with reference to the work of Bion and the embodied defence mechanisms identified by Reich and Lowen. The concepts of mentalisation and epistemic trust, as discussed by Fonagy et al., are viewed as essential to an understanding of the therapeutic relationship. The possibilities offered by therapeutic acceptance are identified with reference to the work of Nathan. Levinas's concept of alterity and awareness of the ‘other’ is introduced, in its applicability to the world of nature and human experience. References are made to the case studies in this book.