Abstract
As dementia care is fundamentally about relationships, a psychodynamic perspective has much to offer given that its focus is primarily on relationships; the thoughts and feelings that we have about one another; and, crucially, on the unconscious processes which ultimately influence our reactions and behaviours.
The book brings a psychodynamic understanding the dementia care journey all the way from diagnosis - and the impact this has on a person - to advanced care planning. In doing so, the book adds to our growing understanding of the lived experience of dementia. It sheds light on the internal world of a person with dementia and reminds us that a person’s emotional life continues even in the absence of verbal language. Psychodynamic theories and understandings do not shy away from difficult emotions and serve to reminds us of just how difficult living with dementia can be, and that people may be experiencing ‘loss, grief, missing parts, anxiety and unease, fear and denial, damaged self-esteem, trauma, persecution and a sense of personal failure’ (p. 42).
In dementia care we talk a lot about behaviour and changes in behaviour. Clinicians and family carers spend vast amounts of time trying to make sense of a person’s motives and feelings and perhaps we often forget about the unconscious mind as a primary source of human behaviour and just how much our feelings, motivations and decisions are influenced by our past experiences. A person may not recall or talk about a difficult relationship, but that relationship might be played out with a carer who they now have to trust in order to provide intimate care.
The book also considers how unconscious processes are played out at team, service and organisation levels in relation to dementia where we are working day in and day out with loss and death.
One of the greatest strengths of this book is the range of authors. The contributors are all clinicians drawn from a wide range of disciplines who are experienced in supporting people with dementia. The book is grounded in their experiences, as they bravely and openly reflect on and share their own interpersonal reactions, forcing the reader to reflect on their own experiences. All the authors share examples from their own working lives and the people they have supported to bring the material to life.
As a clinical psychologist working in dementia I found the book very affirming of my own experiences; reading it felt like I was engaged in reflective supervision or a very good professional development course. I particularly enjoyed the chapter on encountering dementia which was a powerful personal account from Louis Resnick of the feelings evoked and the reminder of how effortful communication can be.
Already being familiar with psychodynamic theory, the concepts covered in the book were not new to me, yet I still found it a thoughtful and helpful reminder of ideas and perspectives which in the biomedical and increasingly fast paced world of dementia care might not always be at the forefront of my mind. However, would-be readers should be mindful that this book is not an introduction to psychodynamic thinking – I felt it assumes some prior understanding and knowledge. It is, nonetheless, a thoughtful read to provoke reflection for clinicians.
