Talking to the most reasonable voice: building rapport within a crisis service

Abstract

This brief report concerns a patient interaction in a busy South London Home Treatment Team (HTT) service, where a psychodynamically informed approach was applied to a presentation of psychosis in a crisis setting. We discuss the case in light of the psychodynamic theories on psychosis of Carl Jung and Richard Lucas. Our patient, a young man, had been under the HTT for an extended period of time due to an episode of psychosis that was not resolving. After initially struggling to build rapport, we adapted Lucas’ and Jung’s models of interacting with acutely psychotic patients to re-establish psychic rapport, which led to our patient agreeing to take the medication that finally pulled him out of this long-standing episode. We believe this case highlights the power of psychodynamic thinking even in acute, short-term settings where extensive psychodynamic intervention may not be appropriate or feasible.