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Forming an Effective Therapeutic Alliance with Difficult to Engage Clients: A Focus on Treatment Resistant Depressive Disorders

Event number: 17496
13 CPD hours
Presenter(s): Dr Stephen Arthey & Mr Pejman Hoviatdoost, MAPS,MCCLP

In this workshop we will focus on the therapeutic alliance, a core component of all psychotherapy and recognised as one of the major predictors of treatment outcomes.  We will focus on how to develop an effective working alliance with difficult to engage clients.  Interventions will be driven by the theory and practice of Intensive Short-Term Dynamic Psychotherapy (ISTDP), but the learning will be applicable to all dynamically/interpersonally-focused therapies.  In this workshop, we’ll be primarily focused on clients with treatment resistant depression (TRD) as they are often difficult to engage therapeutically, but the approach to forming a therapeutic alliance will be applicable across a very broad range of clients with various types of psychological/psychiatric disorders.  

“Treatment resistant depression” typically refers to clients who have had multiple unsuccessful psychological therapies and have also been non-responsive to anti-depressant medications.  These clients can present to treatment in a number of ways: Typically with 'flatness' in the forefront, or with detached, intellectual defenses.  Often, these clients can become quite self-attacking and/or have systems that 'invite' the therapist into a critical, attacking, or dismissing countertransference.  As a result, clients with TRD are typically difficult to engage and it is often hard form a strong therapeutic alliance. 

ISTDP is a structured, short-term, psychodynamic psychotherapy that pays particularly close attention to the therapeutic alliance, recognising both a conscious therapeutic alliance (CTA) and an unconscious therapeutic alliance (UTA).  This enables the ISTDP practitioner to recognise multiple, complex barriers to engagement and to help the client to understand and overcome these problematic ways of relating and thereby, meaningfully engage clients who might otherwise remain locked away behind their defences.

Learning Outcomes

On completion of this workshop you will be able to:

  • Intervene effectively to build and maintain a strong therapeutic alliance;
  • Identify the particular defenses the treatment-resistant patient is manifesting;
  • Help patients recognise their defenses and the problems these defense cause;
  • Help patients to turn against and overcome their defenses, and;
  • Help patients to safely and therapeutically access the underlying emotional conflicts that have been driving the depression.


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About the presenter(s)

Dr Stephen Arthey (Ph.D.) is a clinical psychologist working in private practice in Melbourne, Australia. He has extensive training in Intensive Short-Term Dynamic Psychotherapy (ISTDP) and has published peer reviewed articles on the theory and application of ISTDP as well as having presented over 20 training workshops on ISTDP in Australia and internationally. For the last 6 years, Dr. Arthey has provided supervision in ISTDP and a Core Training program in ISTDP. He now also offers an Advanced Training program for those who have completed a Core Training program.

Mr Pejman Hoviatdoost is a clinical psychologist with extensive experience in working with a broad range of adult psychological problems including treatment resistant depression, anxiety disorders, eating disorders, personality disorders, interpersonal difficulties, and drug and alcohol problems. Pejman specialises in ISTDP and has more than six years of training in this model. Pejman is currently undertaking a PhD with the Queensland University of Technology (QUT); his research aims to better understand the mechanisms of change in ISTDP across the spectrum of psychological disorders. Pejman is a registered clinical supervisor, he provides supervision for private psychologists and psychology students at Griffith University.


This workshop has extensive use of video recorded material from actual treatment sessions and is therefore restricted to mental health professionals (AHPRA registration required).


Mercure Hotel
Palm Meadows Drive
Carrara, QLD 4211
Venue is wheelchair accessible
Start date: 22/7/2017
End date: 23/7/2017
Time: 9:00am-4:00pm each day


APS member: $370
APS student member: $200
Non APS member: $570


APS - Gold Coast Branch
Contact Jessica Paynter
07 5678 7058