More focused attention upon relationship; another call for paradigm shift in psychiatry.

Much of what are understood as ‘mental health difficulties’ reflects shortcomings in the ability to develop and sustain healthy relationships. Many of those embarking upon life as someone with a psychiatric diagnosis are people whose difficulties can be traced to adolescence, or even earlier in life. Unsatisfactory relational experiences during childhood are acknowledged contributors to subsequent psychological vulnerability. Numerous studies identify associations between other forms of relational disturbance, and the onset and maintenance of psychological difficulties. Some eighty years’ psychotherapy research has repeatedly suggested that the quality of therapeutic relationship is a major determinant of outcome. Sophisticated analyses of large databases now confirm this beyond doubt. All concur that social exclusion and stigma are the most disabling consequences of living as someone with a psychiatric diagnosis. None of these facts are disputed but there is continuing resistance to broad acknowledgement of their implications. This has many parallels with other examples of paradigm shift, as so clearly outlined by Thomas Kuhn. Uncertainties about the value of medical psychiatry and growing recognition of the role relationships play in the genesis and relief of mental health difficulties suggest that psychiatry can be seen in similar terms. This paper develops that thesis. [ABSTRACT FROM PUBLISHER]