Therapeutic practice at Bower Place is informed by the management of inequality, which we propose can never be resolved, but must be recognised and managed. Robinson (in press) highlights that the client-practitioner relationship and therapeutic practice are always unequal. Inequality occurs between both client and practitioner and within the wider system in three forms: political, problem, and psychological. Political inequality refers to the unequal relationship between the client (or citizen) who comes to service delivery with the problem, and the practitioner and their organisation that represent the ‘helping institution’ (or state). This inequality is manifest in the power struggle over ownership of the client’s problem (i.e., who has responsibility for its resolution, and who has the authority to either act, or cease the actions, fuelling the problem), which can paralyse the therapeutic process (Sanders & Robinson, in press). Problem inequality recognises that, unlike the practitioner, the client comes with a problem they cannot resolve while revealing private and personal information about their thoughts, feelings and beliefs. Psychological inequality refers to the differentials in intellectual profile (i.e., memory, receptive and expressive language, processing speed), education, anxiety and mental health between client and practitioner (Sanders & Robinson, in press). All act to constrain service delivery and therapeutic practice (Robinson, Sanders, & Maddison, in press).


Developed in our Complex Needs Clinic, BowerNote (Robinson , in press) is a series of protocols for the management of any episode of care provided to clients in the mental health service delivery system that aims to acknowledge and, where possible, modify inequality in therapeutic practice. It provides a comprehensive and contemporaneous note system and protocols for practice that guide the practitioner’s activity within session. Verbal, visual, symbolic and kinaesthetic modalities are used to explore, assess and intervene in the client’s presenting difficulties. BowerNote can be applied to individuals, couples, families and their wider systems regardless of the social and political context or setting, and is applicable to any theoretical model of service delivery (Robinson, in press). If you would like further information on BowerNote or the work we do at the Bower Place Complex Needs Clinic, please contact Carly Case on 08 8261 6066 or via email at



Robinson, M., Sanders, C., & Maddison, C. (2017). BowerNote: Applying the Bower Place Method, in press.

Sanders, C., & Robinson, M. (2017). Putting theory into practice: Training at Bower Place, in press.

Robinson, M. (2017). Inequality in therapeutic practice: The Bower Place perspective, in press.