Psychotherapy in the General Practice Surgery: Working With and Without a Secure Therapeutic Frame

Many general practices employ psychotherapists and counsellors. Some GPs have also had personal therapy and may have training in counselling or various therapies. Where different approaches are used, conflicts and rivalries can arise. This paper describes a flexible model which has helped one practice negotiate these issues. The model permits several levels of work: from opportunistic counselling in ordinary GP surgeries, to formal 'secure-frame' psychotherapy. The model allows patients and practitioners to sculpt their own experiences of counselling and therapy from a variety of approaches, and allows us to combine therapeutic work with medical practice.