'Psychodynamics' refers in a general sense to the interactions between discrete life events, personal relationships, and personality attributes, in addition to its use to cover internal psychological processes (such as defence mechanisms and coping strategies). All of these need to be examined when trying to understand which of several possible causes of an illness at a particular time is the most likely.
A mixture of knowledge about local social and cultural influences and more technical psychological issues is needed for this appraisal of the patient's life story, and suggestions about different components of the overall pattern may well come from different members of the team. The different perspectives in which patients can be viewed are discussed in Chap.te.L1,Z..
The internal psychodynamics of the patient often need to be considered in detail, and one way to do this would be to construct a subdivision of the right-hand side of
Fig 1 to show interpersonal relationships and psychodynamic processes. In some patients a major conclusion of the initial assessment will be that these aspects are paramount, indicating the need for referral to a specialist psychotherapy service. The assessment of suitability for specific forms of psychotherapy and cognitive-behavioural approaches are dealt with in Part 6.
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