This chapter provides an introduction to psychodynamic theory as applied to settings outwith the specialist psychotherapy clinic, paving the way for the chapters that follow in Part 4. An individual’s internal world affects how they relate to others. Others may be unconsciously invited into playing old roles that are familiar to the individual (such as rejecting, not listening, criticising), even though these roles bring difficulty and distress to both sides. This chapter explores how these powerful but sometimes ‘invisible’ interpersonal dynamics may play out between service users and staff in settings where the human relationship is at the fore (such as schools, social service agencies, and hospitals). We also discuss splitting within a clinical team and other system dynamics. In circumstances where services and professionals can sustain a good-enough therapeutic environment in the face of unconscious invitations to repeat a problematic relationship, trust may develop between service user and service and many people are able to discover new ways of forming relationships. This depends partly on the capacities and current state of the person using a service, but also, crucially, on the capacity of the professionals and services to observe and be reflective about both sides of the relationship.

A psychologically informed service is one where the design, practice, and principles of the service are informed by the best understandings of the psychological and emotional needs of people who the service is intended for, with particular consideration to those who struggle to use the service in an uncomplicated way. The need for the concept of a ‘psychologically informed’ service arises because a proportion of people have psychological and emotional needs that may not be appropriately catered for within standard health and social care designs. Care-seeking is one of the most primitive and early relational dynamics we engage in. Experiences described as developmental trauma, neglect, and other mistreatment occur in relationships, often within relationships that are expected to provide safety, security, and comfort. One of the longest legacies of early relational adversity may be a loss of trust in others, which can subsequently give rise to complicated relationships with caring figures. Making a service psychologically informed can be understood as a necessary provision for those who have the highest levels of psychological need. We look at several themes to do with developing psychologically informed services: reflective practice, language used by staff, beginnings and endings of contact, time, ambivalence, and treatment.