Background: Power imbalances exist within many relationships. It is usually discussed within the context of the doctor–patient relationship. However, power imbalances also exist in many other relationships, such as the supervisor–registrar and specialist college–trainee relationships. Paranoia is not only a symptom that can be found in mental illnesses but an experience than can be found in the context of power imbalances. The sense of powerlessness in these relationships may lead to the belief that important outcomes in one’s life are controlled by external forces rather than by ones’ own choice and effort. This provides a fertile backdrop for malign intent to be attributed to the powerful and for paranoia to develop, particularly when the person or people feel out of control or negative events occur. An important question to contemplate is whether partnership is possible in relationships characterized by power imbalances and, if so, how this can be achieved.

Objectives: To explore power, partnership and paranoia in psychiatry from different points of view for registrars and fellows.

Methods: A series of individual presentations will be followed by group discussion with the presenting panel.

Conclusions: Consideration of power imbalances is particularly important in psychiatry and can be manifested in many relationships. Trying to work in partnership is particularly important because of this, and this process needs to start by acknowledging the power differentials first and their possible ramifications.