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
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
A key implication is the value of therapists becoming more explicitly
aware of their own particular narratives and the effect these have on the