Psychotherapeutic leadership and containment in psychiatry

Abstract

SUMMARYLeadership is a key role for psychiatrists, with many models that can be adopted depending in part on the nature of the individual and their training, the primary task of the team and the nature of the organisation. In this article we suggest a new concept and model of leadership, ‘psychotherapeutic leadership’. We discuss the theoretical background to this model, its benefits and the implications for training and professional development.LEARNING OBJECTIVES•Understand the concept and role of the psychiatrist in providing psychotherapeutic leadership at an individual patient, team and organisational level•Explore how applying an understanding of psychodynamic principles in practice can provide containment in psychiatry and aid clinical leadership•Understand the role of psychotherapeutically informed approaches in recognising factors influencing staff morale and burnoutDECLARATION OF INTERESTNone.

Experiences of crisis care among service users with complex emotional needs or a diagnosis of 'personality disorder', and other stakeholders: systematic review and meta-synthesis of the qualitative literature

“…27,33,36 The concept of ‘containment’ from the psychotherapeutic literature 37 helps to consider how the emotions of the service user are processed by the person aiming to provide care, and is key to staff members’ ability to respond in a helpful way to distress. 31,38 In this review, staff reported an insufficient level of emotional support in the workplace, which is consistent with previous qualitative research on healthcare staff working with service users with CEN. 27 In literature studying care for people with CEN across the mental healthcare system, staff reported difficult feelings being elicited in the course of their work, such as feelings of inadequacy or frustration, and being unsure how to respond to this.…”

A scoping review of the literature pertaining to burnout and leadership in mental health clinicians

“…Within the included literature, six articles reported novel theoretical ideas or opinions; of these, three articles outlined specific models of supervision or leadership (Abassary and Goodrich, 2014; Gibson et al , 2019; Jones and Branco, 2020) and three were general descriptions of factors considered by the authors of the articles to be important in leadership or supervision (Gabel, 2011; Gabel, 2012; Worrell, 2018).…”

“…The other named models of leadership include leader member exchange theory (Layton, 2019), authoritarian or democratic leadership styles (Brewer, 1994; Gabel, 2012), psychotherapeutic leadership style (Gibson et al , 2019), the servant leadership style (Grunhaus, 2018) and social or instrumental leadership styles (Melchior et al , 1997). Of these articles only four could be labelled as a primary research and only one was published (Melchior et al , 1997); the other pieces of research were unpublished dissertations (Brewer, 1994; Grunhaus, 2018; Layton, 2019).…”

“…A general supportive approach from leadership, outside of a one-to-one supervision session, was deemed important by 12 articles (Abassary and Goodrich, 2014; Coates and Howe, 2015; Gabel, 2012; Gibson et al , 2019; Jones, 2017; Lubofsky, 2002; Melchior et al , 1997; Morse et al , 2012; O’Connor et al , 2018; Onyett, 2011; Pedrini et al , 2009; Webster and Hackett, 1999). This concept was mostly measured by self-report surveys completed by the clinicians and a clear definition was difficult to find.…”

“…Several articles also spoke of the importance of a general supportive culture in reducing burnout, which many suggested was under the influence of leadership by way of modelling attitudes, fostering supportive atmospheres and encouraging collaborative working styles (Gibson et al , 2019; Jones, 2017; Lasalvia et al , 2009; O’Connor et al , 2018; Onyett, 2011; Roncalli and Byrne, 2016; Schulz et al , 1995).…”