Professional knowledge in therapeutic practice: Clinical reasoning as a "hazardous journey"

This thesis explores the therapist's use of professional knowledge in their relationship with patients. It addresses a gap between theory and practice and the challenges to therapist expertise in a postmodern climate in which there are a multiplicity of competing perspectives about psychological problems. In semi-structured interviews eight NHS Psychodynamic Psychotherapists revealed narratives that underpinned their practice about the nature and treatment of psychological problems. These were organised as narratives about living the `good life' psychologically, and the origins and treatment of psychological problems. The central finding of this thesis is that, rather than relying on professional knowledge conceived as conventional psychodynamic theory, therapists engage in a largely intuitive process I have termed `clinical reasoning' which is practice-based, `reflection-in-action' that involves tacking principally between their professional knowledge base, their experience with the patient and their personal beliefs and experience. Such a process, I argue, constitutes a `hazardous journey' in a postmodern climate in which the value of a psychodynamic perspective cannot be taken for granted. A key implication is the value of therapists becoming more explicitly aware of their own particular narratives and the effect these have on the therapeutic encounter.