This chapter traces the origins of psychodynamic psychotherapy back to the late eighteenth century and to the development of ‘moral treatment’ by Pinel in Paris and William Tuke in York. It also considers the contribution of Mesmer’s theory of animal magnetism, and its revival as hypnotism in the second half of the nineteenth century by Jean-Martin Charcot and others. It then goes on to consider the work of Freud and the various critiques of his theories. Next the chapter considers the phenomenon of shell shock in the First World War and how it led to further developments in psychotherapy. It then looks at the creation of the Tavistock Clinic in the early twentieth century and the work of Anna Freud and Melanie Klein. Object relations theory is outlined, and the work of therapists such as Fairbairn, Bowlby, and Winnicott is examined. Finally the chapter briefly considers ‘the turn to the child’ in psychotherapy, the development of group psychotherapy, and the attempts to treat psychosis with psychotherapeutic methods.

This chapter gives an account of the different psychoanalytic traditions and their approaches to PD: the Kleinian/Bionian model, the British object relations perspective, Kohut’s self psychology, the structural object relations model, the interpersonal-relational approach, and mentalizing theory. The chapter goes on to describe two contemporary psychodynamic treatments, along with their evidence base: transference-focused therapy and mentalization-based treatment. Recent developments in the authors’ thinking in relation to PD are then described, partly in the context of recent work in the area of a general psychopathology or “p” factor. In particular, the authors discuss personality disorder in relation to epistemic trust, and suggest that psychopathology might be understood as a form of disordered social cognition, perpetuated by the obstacles to communication that these social cognitive difficulties create. It is postulated that effective therapeutic interventions for PD possess the shared characteristic of stimulating epistemic trust and creating a virtuous circle of improved social communication.