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This chapter establishes a formal notation for development and maintenance formulations which support agreed rationales for self-managed change. The meta-representation of first-person meanings and motivations becomes an application of how to understand intentionality enacted through a set of social skills whereby clients of all abilities can enter a discussion about their own well being. Such a discussion should help them take responsibility for their own mental health and become more effective in their relationships with others outside of sessions. The order of topics below begins with recapping the view of solo consciousness and the primary phenomenon of the object but this time in a wider context of the possible change from distress to one of self-managed recovery and greater well-being. To increase clients' ability to reflect and understand it is necessary to understand key intentional processes in the previous maintenance and accrual of distress in their earlier lives. All such discussions have the aim of helping them release themselves from habits and beliefs that keep them tied to a narrowed lifestyle. Four major forms of maintenance of syndromes are posited in a way that includes the contributions of biological cause as well as including intersubjective meanings and motivations, the intentional "causes". There are a large number of ways of working with the research literature on effectiveness, the accuracy of diagnosis and how to work with the relationship. This chapter accepts the following items to argue for a consensus position that accepts diagnosis as a hermeneutic art and not a science as it is correctly based on understanding the course of people's difficulties and their personalities. Firstly, what is most important is to recognise that both contextually-occurring syndromes co-occur as complex psychological meaning, cultural objects that are given the names PTSD, depression and personality disorder. However, to support working with the relationship to keep these difficulties together is genuinely wholistic way of thinking with clients about how they interact. In a detailed view it is noted in the literature that syndromes are not discrete but are variations on a theme (Bentall 2009; Hyman 2010). For instance, although a person can have PTSD there are specific forms that this can have such as connections with a changed identity and esteem, depression, with anxiety problems such as panic or worry, or with pain and other long-standing personality problems. Given that intentionality is what characterises a psychological model of the basic building blocks of the meanings called "PTSD" or depression, and that the majority of therapy and mental health care is about techniques for altering meaning and working with the relationship because the most effective way forwards is working with people and following a series of basic procedures of treating people with respect and being open and honest about what can be achieved and clear in how to achieve it (Norcoss and Lambert 2011).

DOI: 10.1007/978-3-319-13605-9_14

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