As an adjunct to, or instead of pharmacotherapy, psychotherapeutic interventions have long been used as a basis of treatment for mental illness. The therapeutic relationship is identified as a crucial component of psychotherapeutic interventions, and predictive of successful treatment outcomes. This literature review will identify and briefly explore psychotherapeutic approaches identified as current best practice, and the clear link to the therapeutic relationship as efficacious for successful treatment. The therapeutic relationship is then further identified as an independent area of theoretical construct and practice before the focus is directed toward the current context of community mental health care.
Fundamental change to public health systems identify nationally driven restructuring of health services which incorporate the delivery of public mental health care under a single governance structure. The new Victorian Mental Health Act reflects an evidence based, client – centred recovery approach, delivered via community – based models of care. The therapeutic relationship remains vital to successful practice supporting positive client outcomes. There are significant implications for adult community mental health services in training and supporting clinical staff to achieve the best outcomes for a vulnerable client population.
The search strategy incorporated multiple databases including: Google scholar, Cochrane database, Psychinfo online, Proquest central, Psychiatry online, Psyc Arctiles, CINAHL. These databases provided access to numerous journals, some denying access to full article information. In these cases the assistance of the librarian at Bendigo Health was most helpful, providing full access to all articles requested. Support was also accessed via the La Trobe University librarian (Bendigo campus).
Search combinations included ‘psychotherapy’ and ‘therapeutic relationship’, ‘therapeutic alliance’, ‘working alliance’; ‘interpersonal therapy’, ‘cognitive behavioural therapy’, ‘psychodynamic therapy’, ‘mindfulness’, ‘community’ and ‘mental’ and ‘health’. Further related searches included ‘rupture’ and ‘repair’, ‘recovery’, ‘evidence based practice’. Multiple combinations of stated words were utilised. The Commonwealth Government Department of Health and Aging was a primary source of policy – based information as was the Victorian Government Department of Health for policy, recovery based literature and the Mental Health Act (2014).
Psychotherapy is regarded as “a core clinical activity of psychiatrists, psychologists, social workers and other mental health care professionals.” (Olfson & Marcus, 2010:1456). Psychotherapy is often used in conjunction with pharmacotherapy, or as ‘stand alone’ therapy for mental health issues (Olfson & Marcus, 2010). Main psychotherapeutic approaches currently located as best practice, are briefly explored, with a focus on the role of the therapeutic relationship as part of each area of psychotherapy.