It's time to ditch the 'therapeutic relationship'

Steve Flatt argues that the NHS needs to ditch the bogus 'therapeutic relationship' for a partnership approach that assumes patients are experts in their own lives.

Steve Flatt argues that NHS mental health nursing needs to abandon the 'therapeutic relationship' for a partnership approach that assumes patients are experts in their own lives 

Over the past 30 years, the psychology of the western world has changed beyond recognition due to technological advances such as the internet and hugely increased control from professionals over so many aspects of our lives.

Susskind and Susskind suggest 'the profession(s), individually exercise a license to do things others do not do, but collectively they presume to tell society what is good and right for it in a broad and crucial aspect of life'.

Psychiatry is probably more responsible for using this approach than most – it assumes ascendancy over the vulnerable in our society, labels them and manages their lives.

It is so easy to check information on the web and we no longer accept the word of a professional. People are uncovering half-truths and outright lies told to them by politicians, bankers, economists, lawyers, the list is endless.

The questioning related to our mental well being is just beginning and as people become more knowledgeable about their own psychology that little trickle will become a tsunami and traditional approaches will be swept away as people begin to understand their own behaviours and question professionals’ authority.

Changing approaches

Some of us working in mental health outside the NHS have already transformed our approach and create real partnerships, abandoning the 'therapeutic relationship', which never existed in any case.

We work with people as equals and seek to discover their aspirations to get you the best result for them. We no longer try to provide a ‘one-size-fits-all’ approach but assume the person is the ‘expert in their own lives’ – only they really know what they want and think.

The future for mental health nursing is not about becoming more technical and ‘all knowing’ but getting into the real world ‘between the noses’ of observable evidence and behaviour and away from interpretations and assumptions.


Susskind R, Susskind D (2015) The Future of the Professions: How Technology Will Transform the Work of Human Experts. Kindle edition. Oxford University Press.


Steve Flatt

Steve Flatt is director of the psychological therapies unit, Liverpool

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