I, Me, You & Us: can a psychodynamic model provide a relational perspective on psychosis?

Abstract

The concept of psychosis existed long before the current diagnostic definitions we have today. However, current opinion and treatment of psychosis is often dominated by a narrow psychiatric discourse. As a result of this conceptualisation, a diagnosis of psychosis can often feel limiting and disempowering for the individual, especially if he or she holds an alternative perspective. A psychodynamic model may therefore provide a method to examine psychosis from a relational perspective; this may, in turn, broaden one’s understanding and experience of a psychotic episode. In this article, two case examples from different cultural perspectives are used to highlight and explore the potential benefit of psychodynamic theory in the formulation and treatment of psychosis. A psychodynamic model using object relations theory is used for the exploration of both internal and external relational experiences. Both psychodynamic and psychiatric rationales are thus challenged to reflect on the impact of rigid perspectives and how they may limit treatment efficacy. Current research and literature around the use of psychodynamic theory in the treatment of psychosis is reviewed in light of this perspective.