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Forming an Effective Therapeutic Alliance with Difficult to Engage Clients: A Focus on Treatment Resistant Depressive Disorders

July 22 @ 9:00 AM - July 23 @ 5:00 PM


Presented by: Dr Stephen Arthey & Mr Pejman Hooviatdoost

In this workshop we will focus on the therapeutic alliance, a core component of all psychotherapy and recognized as one of the major predictors of treatment outcomes.  We will focus on how to develop an effective working alliance with difficult to engage clients.  Interventions will be driven by the theory and practice of Intensive Short-Term Dynamic Psychotherapy (ISTDP), but the learning will be applicable to all dynamically/interpersonally-focused therapies.  In this workshop, we’ll be primarily focused on clients with treatment resistant depression (TRD) as they are often difficult to engage therapeutically, but the approach to forming a therapeutic alliance will be applicable across a very broad range of clients with various types of psychological/psychiatric disorders.

“Treatment resistant depression” typically refers to clients who have had multiple unsuccessful psychological therapies and have also been non-responsive to anti-depressant medications.  These clients can present to treatment in a number of ways: Typically with ‘flatness’ in the forefront, or with detached, intellectual defenses.  Often, these clients can become quite self-attacking and/or have systems that ‘invite’ the therapist into a critical, attacking, or dismissing countertransference.  As a result, clients with TRD are typically difficult to engage and it is often hard form a strong therapeutic alliance.

ISTDP is a structured, short-term, psychodynamic psychotherapy that pays particularly close attention to the therapeutic alliance, recognizing both a conscious therapeutic alliance (CTA) and an unconscious therapeutic alliance (UTA).  This enables the ISTDP practitioner to recognise multiple, complex barriers to engagement and to help the client to understand and overcome these problematic ways of relating and thereby meaningfully engage clients who might otherwise remain locked away behind their defenses.

In this workshop we will learn to:

  1. Effectively intervene to build and maintain a strong therapeutic alliance;
  2. Identify the particular defenses the treatment-resistant patient is manifesting;
  3. Help the patient recognise their defenses and the problems these defense cause;
  4. Help the patient to turn against and overcome their defenses, and;
  5. Help the patient to safely and therapeutically access the underlying emotional conflicts that have been driving the depression.

All of this will be taught and demonstrated through extensive use of video recordings from actual psychotherapy sessions.


July 22 @ 9:00 AM
July 23 @ 5:00 PM
Event Category:


Dr Stephen Arthey
+61 421 641 912


Mercure Hotel
Palm Meadows Drive
Carrara, QLD 4211 Australia
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+61 7 55557700