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Psychotherapeutic leadership and containment in psychiatry

  • Russell Gibson (a1), Alex Till (a2) and Gwen Adshead (a3)

Leadership is a key role for psychiatrists, with many models that can be adopted depending in part on the nature of the individual and their training, the primary task of the team and the nature of the organisation. In this article we suggest a new concept and model of leadership, ‘psychotherapeutic leadership’. We discuss the theoretical background to this model, its benefits and the implications for training and professional development.


  • Understand the concept and role of the psychiatrist in providing psychotherapeutic leadership at an individual patient, team and organisational level
  • Explore how applying an understanding of psychodynamic principles in practice can provide containment in psychiatry and aid clinical leadership
  • Understand the role of psychotherapeutically informed approaches in recognising factors influencing staff morale and burnout



Corresponding author
Correspondence Dr Russell Gibson, College House, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK. Email:
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Academy of Medical Royal Colleges (2014) Guidance for Taking Responsibility: Accountable Clinicians and Informed Patients. Academy of Medical Royal Colleges.
Agrawal, HR, Gunderson, J, Holmes, BM, et al. (2004) Attachment studies with borderline patients: a review. Harvard Review of Psychiatry, 12: 94104.
Allison, S, Goodall, A, Bastiampillai, T (2016) Expert leadership – why psychiatrists should lead mental health services. Australas Psychiatry, 24: 225–7.
Barsade, SG (2002) The ripple effect: emotional contagion and its influence on group behavior. Administrative Science Quarterly, 47: 644–75.
Berwick, D (2013) A Promise to Learn – A Commitment to Act: Improving the Safety of Patients in England. National Advisory Group on the Safety of Patients in England.
Bhugra, D, Ventriglio, A, Kuzman, MR, et al. (2015) EPA guidance on the role and responsibilities of psychiatrists. European Psychiatry, 30: 417–22.
Bion, WR (1985) Container and contained. Group Relations Reader, 2(8): 127–33.
Cammell, P, Amos, J, Baigent, M (2016) How can psychiatrists offer psychotherapeutic leadership in the public sector? Australasian Psychiatry, 24: 246–8.
Care Quality Commission (2017) The State of Care in Acute NHS Hospitals. Care Quality Commission.
Craddock, N, Kerr, M, Thapar, A (2010) What is the core expertise of the psychiatrist? Psychiatrist, 34: 457–60.
Cramer, P (2000) Defense mechanisms in psychology today: further processes for adaptation. American Psychologist, 55: 637–46.
De Waal, H (2013) Clinical leadership. In Leadership in Psychiatry (ed Bhugra, D, Ruiz, P, Gupta, S): 7488. Wiley Blackwell.
Deary, IJ, Agius, R, Sadler, A (1996) Personality and stress in consultant psychiatrists. International Journal of Social Psychiatry, 42: 112–23.
Dekker, SW, Breakey, H (2016) ‘Just culture:’ improving safety by achieving substantive, procedural and restorative justice. Safety Science, 85: 187–93.
Department of Health (2005) New Ways of Working for Psychiatrists: Enhancing Effective, Person-Centred Services through New Ways of Working in Multidisciplinary and Multi-Agency Contexts. Department of Health.
Department of Health (2010) Responsibility and Accountability: Moving on for New Ways of Working to a Creative, Capable Workforce. Best Practice Guidance. Department of Health.
Devon Partnership NHS Trust (2017) The CHANGE Programme – What Does It Mean for Me? Information for People Using Our Services. Devon Partnership NHS Trust (
Donetto, S, Tsianakas, V, Glenn, R (2014) Using Experience-Based Co-design (EBCD) to Improve the Quality of Healthcare: Mapping Where We Are Now and Establishing Future Directions: Final Report. King's College London.
Fothergill, A, Edwards, D, Burnard, P (2004) Stress, burnout, coping and stress management in psychiatrists: findings from a systematic review. International Journal of Social Psychiatry, 50: 5465.
Francis, R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: Executive Summary. TSO (The Stationery Office).
Freud, S (1938) The Basic Writings of Sigmund Freud. Modern Library.
Gair, G, Hartley, T (2001) Medical dominance in multi-disciplinary teamwork: a case study of discharge decision making in a geriatric assessment unit. Journal of Nursing Management, 9: 311.
Gee, M (2007) New Ways of Working threatens the future of the psychiatric profession. Psychiatric Bulletin, 31: 315.
Goleman, D (1998) The emotional intelligence of leaders. Leader to Leader, 10: 20–6.
Goleman, D (2017) Leadership That Gets Results. Harvard Business Review Press.
Goodall, AH (2016) A theory of expert leadership (TEL) in psychiatry. Australasian Psychiatry, 24: 231–4.
Graham, S, Gask, L, Swift, G, et al. (2009) Balint-style case discussion groups in psychiatric training: an evaluation. Academic Psychiatry, 33: 198203.
Green, AE, Albanese, BJ, Shapiro, NM, et al. (2014) The roles of individual and organizational factors in burnout among community-based mental health service providers. Psychological Services, 11: 41–9.
Grenyer, B (2014) An integrative relational step-down model of care: the Project Air Strategy for Personality Disorders. ACPARIAN (Australian Clinical Psychologist), (9): 813.
Hall, LH, Johnson, J, Watt, I, Tsipa, A, O'Connor, DB (2016) Healthcare staff wellbeing, burnout, and patient safety: a systematic review. PLoS One, 8, 11: e0159015.
Hinshelwood, RD, Skogstad, W (2002) Observing Organisations: Anxiety, Defence and Culture in Health Care. Routledge.
Hunter, J, Maunder, RG (2001) Using attachment theory to understand illness behavior. General Hospital Psychiatry, 23: 177–82.
Imo, UO (2017) Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. BJPsych Bulletin, 41: 197204.
Iszatt-White, M (2009) Leadership as emotional labour: the effortful accomplishment of valuing practices. Leadership, 5: 447–67.
Johnson, JM, Stern, TA (2013) Preparing psychiatrists for leadership roles in healthcare. Academic Psychiatry, 37: 297300.
Kahneman, D (2011) Thinking, Fast and Slow. Penguin.
Katschnig, H (2010) Are psychiatrists an endangered species? Observations on internal and external challenges to the profession. World Psychiatry, 9: 21–8.
King's Fund (2011) The Future of Leadership and Management in the NHS: No More Heroes. The King's Fund.
King's Fund (2015) Briefing: Mental Health Under Pressure. The King's Fund.
Kumar, S, Fischer, J, Robinson, E, et al. (2007) Burnout and job satisfaction in New Zealand psychiatrists: a national study. International Journal of Social Psychiatry, 53: 306–16.
Lasalvia, A, Bonetto, C, Bertani, M, et al. (2009) Influence of perceived organisational factors on job burnout: survey of community mental health staff. British Journal of Psychiatry, 195: 537–44.
Lovett, K (2017) Increasing the number of mental health staff must be a priority. Health Service Journal, 7 July.
Maslach, C (1982) Burnout: The Cost of Caring. Prentice-Hall.
Menon, A, Flannigan, C, Tacchi, M, et al. (2015) Burnout – or heartburn? A psychoanalytic view on staff burnout in the context of service transformation in a crisis service in Leeds. Psychoanalytic Psychotherapy, 29: 330–42.
Morse, G, Salyers, MP, Rollins, A, et al. (2012) Burnout in mental health services: a review of the problem and its remediation. Administration and Policy in Mental Health, 39: 341–52.
National Offender Management Service (2015) The Offender Personality Disorder Pathway Strategy 2015 (Gateway Reference 04272). National Offender Management Service/NHS England.
O'Sullivan, H, McKimm, J (2014) The role of emotion in effective clinical leadership and compassionate care. British Journal of Hospital Medicine, 75: 281–6.
Perry, J, Mason, FL (2016) The value of psychiatrists in leadership and management. BJPsych Advances, 22: 263–8.
Plakiotis, C (2017) Psychodynamic leadership approach and leader–member exchange (LMX): a psychiatric perspective on two leadership theories and implications for training future psychiatrist leaders. In GeNeDis 2016 (ed Vlamos, P): 97111 (Advances in Experimental Medicine and Biology, vol 988). Springer.
Project Air Strategy for Personality Disorders (2015) Treatment Guidelines for Personality Disorders (2nd edn). NSW Health, Illawarra Health and Medical Research Institute.
Reed, J (1991) The future for psychiatry. Psychiatric Bulletin, 15: 396401.
Riordan, C, Weatherly, E (1999) Defining and measuring employees’ identification with their work groups. Educational and Psychological Measurement, 59: 310–24.
Royal College of Psychiatrists (2009) Mental Health and the Economic Downturn: National Priorities and NHS Solutions (Occasional Paper OP70). Royal College of Psychiatrists.
Royal College of Psychiatrists (2010) Role of the Consultant Psychiatrist: Leadership and Excellence in Mental Health Services (Occasional Paper OP74). Royal College of Psychiatrists.
Royal College of Psychiatrists (2016) CT1-3 Psychotherapy Trainee Guide. Royal College of Psychiatrists.
Shapiro, J, Galowitz, P (2016) Peer support for clinicians: a programmatic approach. Academic Medicine, 91(9): 1200–4.
Solomon, J, George, C (1996) Defining the caregiving system: toward a theory of caregiving. Infant Mental Health Journal, 17: 183–97.
South London and Maudsley NHS Foundation Trust, South West London and St George's Mental Health NHS Trust (2010) Recovery is for All: Hope, Agency and Opportunity in Psychiatry. A Position Statement by Consultant Psychiatrists. SLAM/SWLSTG.
Storey, J, Holti, R (2013) Towards a New Model of Leadership for the NHS. NHS Leadership Academy.
Vahey, DC, Aiken, LH, Sloane, DM, et al. (2004) Nurse burnout and patient satisfaction. Medical Care, 42(suppl 2): II57–66.
Ward, G, Van de Loo, E, ten Have, S (2014) Psychodynamic group executive coaching: a literature review. International Journal of Evidence Based Coaching and Mentoring, 12(1): 6378.
Weng, HC, Hung, CM, Liu, YT, et al. (2011) Associations between emotional intelligence and doctor burnout, job satisfaction and patient satisfaction. Medical Education, 45: 835–42.
West, M, Eckert, R, Steward, K, et al. (2014) Developing Collective Leadership for Healthcare. The King's Fund.
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Psychotherapeutic leadership and containment in psychiatry

  • Russell Gibson (a1), Alex Till (a2) and Gwen Adshead (a3)
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