A Psychodynamic Understanding of Modern Medicine, Placing the Person at the Centre of Care
O’Reilly-Landry, Maureen (Eds)
Radcliffe Publishing, 2012
Reviewer Vivian de Villiers
This book is in my view essential reading, not only for health professionals but also for psychotherapists, counsellors and psychologists. It addresses psychological challenges related to interventions such as for example organ transplants, assisted suicide and chronic illness, by authors at the cutting edge of new developments. The language and psychodynamic concepts used are of the present era with Freud mentioned in context and the work of Bowlby, Mary Ainsworth and Peter Fonagy having a central position.
The psychodynamic aspects of ‘baby making’ is for example a development in medical science where mental health issues have lagged behind, trying to catch up. The term ‘birth other’ is introduced for sperm and egg donors and surrogate or gestational carriers and challenges that those involved have to face are dealt with in one of the many excellent chapters. Similarly, some of the challenges for parents who have a neonate in the intensive care unit for months, unable to hold the baby and when they go home with the baby, who is not perfect, feeling guilt and shame, are explored. Staff have to cope with forming a bond with the neonate who they look after for months knowing that the child is at an increased risk of dying. I feel that one of the factors making this book worth reading is that it looks at dynamics as a whole, considering the experiences of the patients as well as of the service providers.
Norka Malberg and Peter Fonagy co-authored an excellent chapter about the dynamics in a renal dialysis unit with adolescent patients. They describe how they had to be creative to set up a therapy group in the unit to overcome factors such as the loud sounds of the dialysis machines, the physical layout, and the ‘ongoing traffic of service providers, family and friends’. A patient secluded in the ‘sick room’ was for example included in the group by the use of a ‘walkie-talkie’, which became also a useful tool for nursing staff to remain in contact with the patient in isolation. If a patient did not want to take part in a group session this could be done by wearing earphones or watching a film. It became possible to provide mentalization based group therapy to promote long-term shifts in relational and problem solving strategies within the unit by adapting and evolving with the environment. The chapter also clearly defines what is meant by mentalization.
Throughout the book attachment styles are mentioned and in one chapter the matching and mismatching between the therapists’ and the patients’ attachment styles are discussed. An interesting comment is ascribed to Jeremy Holmes; when asked how the attachment style between psychotherapist and patient affects psychotherapy, he apparently remarked, paraphrased: dismissing plus dismissing – therapy never starts, preoccupied plus preoccupied – therapy never ends. The placebo and nocebo (negative placebo) effects are also explored in relation to attachment theory, which is new, and validated as a fascinating area with much scope for further research focusing on the emotional response of the patient to an illness. Therapeutic stances that are more likely to evoke placebo responses usefully are also discussed.
I have only touched on a few topics given that the book has twenty chapters although crammed into 222 pages. The chapters are short, easy to read and give a real feel for the activities that take place in the different settings. The trauma that staff are exposed to is acknowledged throughout the book, noticing for example that staff and people in general tend to go into hyperactivity mode in traumatic situations. I concur with the view expressed in the book that psychodynamic training has a crucial part to play in learning how to manage the stress and distress working in traumatizing settings. I recommend this book given that psychotherapists and counsellors will inevitably come into contact with clients who are going or have gone through modern medical treatments; it gives an insight into the associated psychodynamic experiences that those patients and their relatives would have to deal with.