Brendan McMahon, MSc, BA (Hons), SRN, RMN, Cert Psychodynamic Psychotherapy.
Clinical Nurse Specialist in Dynamic Psychotherapy, Southern Derbyshire Mental Health and Community TrustThis paper describes how a clinical nurse specialist carried out short-term focal psychotherapy in a community setting. It is asserted that such therapy has an important therapeutic impact, given appropriate assessment procedures, and that liaison between colleagues can ensure better care.
Practising therapy in this setting has several advantages. Many patients, particularly those with with difficult child-care arrangements, find it easier to attend the team base than the central psychotherapy unit. It is also possible to have useful discussions with occupational therapy and nursing colleagues who may have already seen the patient, instead of having to rely on often sketchy referrals. This can help identify inappropriate referrals and save the patient from having to endure an unnecessary assessment. Examples of patients that would be suitable for referral for psychotherapy are shown in Box 1.
The author is trained in analytic psychotherapy, and the model used is long-term psychodynamically oriented therapy. Based on the clinical and theoretical work of Sigmund Freud, Melanie Klein, Donald Winnicott and others, this approach is founded on the belief that psychological symptoms, anxiety, depression and the like are rooted in unresolved emotional conflicts, of which the patient themselves may not be aware.
Psychoanalysis, as taught by Freud and practised by his successors, was and is a lengthy process. Analysts see their patients four or five times a week. Analytic psychotherapy, though it usually involves seeing the patient once a week, can also take years.
To be effective, such short-term therapies, like all others, have to be based on accurate assessment (Coltart, 1988).
Jane Green's GP referred her to the author, as the CMHT's clinical nurse specialist in psychodynamic psychotherapy. The referral was at the request of the practice's counsellor, who had seen her five or six times. When referred for counselling, Mrs Green, who was in her early 30s, had been suffering from depression and anxiety, associated with a poor self-image. She considered herself to be ugly and stupid, whereas on any objective assessment she was articulate, intelligent and attractive. She was married with one child, and her main reason for seeking help was that she did not want her difficulties to affect her relationship with her young son.
Dynamic psychotherapy, which has from the outset been based on qualitative, clinically based evidence, attempts to identify the nature of the relationships which have shaped the client's experience often in pathological ways, and to help him or her to understand and mitigate their effects. While it is impossible to do justice in a paper of this length, it is hoped that this paper gives some idea of its therapeutic potential.
Information on nurses in psychotherapy can be obtained from:
Derby Psychotherapy Unit,
Mill Hill Lane,
Derby DE23 6SE.
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