The consultation is likely to be the first experience the patient has of a psychodynamic way of thinking and it has the potential to be an experience of being deeply heard and understood. In the consultation period the aim is for the therapist to have an experience of the internal world of the patient and the patient an experience of what the therapy will be like. A consultation over a series of meetings may even give the opportunity of developing a patient’s capacity to undertake therapeutic work. It is a complex process that often starts before the patient even enters the room. There are different approaches to the consultation process and some of these are discussed. Given that the psychodynamic consultation is an encounter which will, in all likelihood, create anxiety and a sense of vulnerability in the patient, we can expect to see defences emerging in the moment-by-moment interaction and these are considered. A tripartite structure of psychodynamic formulation is outlined as a helpful framework for picking out the relational dynamic

This chapter provides an overview of current thinking regarding the supporting theory of psychodynamic psychotherapy. Rather than going through theoretical constructs in historical order of when each theory was proposed, they are presented as a composite of past and present thinking that the authors have found to be clinically relevant. It commences by describing theories on the early development of the infant and the creation of the internal world and object relations. The chapter them moves on to the issue of accommodating to the world as it is experienced by the infant, outlining circumstances leading to adaptive and less adaptive development. The chapter then outlines ‘core theory’ which covers more traditional psychodynamic concepts such as conflict, resistance, and defence mechanisms with an emphasis on projective identification. The role of this latter defence mechanism is linked with the theoretical constructs of transference and countertransference. There is a section on the narcissistic constellation in order to help the reader negotiate later sections in the book. Finally the chapter concludes with an introduction to theories as to how change is effected in psychodynamic psychotherapy.

Chapter 9 examines a second necessary extension of the analysis of social influence to a consideration of the effects of designed artefacts in social relations. The chapter starts with an elaboration of the notion of inter-objectivity: designed hardware permeates human social relations as infrastructure, tools, gadgets and instruments. How is different hardware used to implement modalities of social influence? Crowds have historically used barricades to enhance their power. People easily recognise the fait accompli, for example as a wall, installed in a collective effort of construction. Such installations provide boundaries and parameters of attitudes and behaviour afforded by design, but do so without prior consent. Legitimation is achieved post-hoc by cognitive dissonance in analogy to forced-compliance. Resistance to such faits accompli is introduced as a hitherto unrecognised modality of social influence. It functions to evaluate and to redesign hardware and systems in ways that correct the initial designs; resistance potentially innovates on the 'innovation'.