1st Edition

Psychodynamic Approaches to the Experience of Dementia Perspectives from Observation, Theory and Practice

Edited By Sandra Evans, Jane Garner, Rachel Darnley Smith Copyright 2020
    268 Pages
    by Routledge

    268 Pages
    by Routledge

    Psychodynamic Approaches to the Experience of Dementia: Perspectives from Observation, Theory and Practice demonstrates the impact of healthcare approaches that take into account not only the practical needs but also the emotional experience of the patient, their partners, families and friends, lay carers and professional staff.

    Currently there is no cure for dementia, but the psychosocial and therapeutic approaches described in this volume have appeared to help people, both patients and carers, feel more contained and less lonely and isolated. Psychoanalytic theory provides a disciplined way of thinking about the internal world of an individual and their relationships. Each author provides their own commentary on the personal and interpersonal effects of dementia, endeavouring to understand behaviours and emotions which may otherwise seem incomprehensible. The subject is approached from a psychodynamic perspective, considering the unconscious, previous and current experiences and relationships, including those between patients and staff.

    Psychodynamic Approaches to the Experience of Dementia illustrates the practical and theoretical thinking of clinicians from a wide range of disciplines who are engaged in the care of people in late life with a diagnosis of dementia. It will be essential reading for mental health and health professionals in practice and training in the field of dementia.

    List of figures and illustrations

    List of contributors

    Foreword by Nori Graham



    Sandra Evans, Jane Garner and Rachel Darnley-Smith

    1. Encountering dementia

    Louis Resnick

    2. Where lies the expert?

    Jane Garner

    3. Working with people with mild neurocognitive disorders (mild NCD) or mild cognitive impairments (MCI)

    Julia C. Segal

    4. Prognosis and planning: advance care planning through a psychoanalytic frame

    Juliette Brown

    5. The experience of loss in dementia; melancholia without the mourning?

    Sandra Evans

    6. Dementia and dialogue: acute hospitals and Liaison psychiatry

    Matthew Hagger

    7. Psychodynamic interventions in dementia: the Australian and New Zealand experience

    Neil Jeyasingam

    8. Art therapy with people with dementia: the present and the past

    Angela Byers

    9. Attachment in confusional states and in dementia: theory into practice

    Sandra Evans

    10. The fragile thread of connection: living as a couple with dementia

    Andrew Balfour

    11. Maintaining boundaries: counselling in a care home

    Susan Maciver, Chris McGregor and Tom C. Russ

    12. Music as mirror in the care of elderly people with dementia

    Rachel Darnley-Smith

    13. Groups for people with cognitive impairment and with dementia: what should we be doing?

    Sandra Evans

    14. Disintegration and integration in dementia care: mentalisation as a means to keep whole

    Stephanie Petty, Michelle Potts and Daniel Anderson

    15. A psychoanalytic and philosophical exploration of boredom and disengagement in dementia

    Sandra Evans

    16. Continuing care review: a report on a thoughtful project and its untimely demise

    Jane Garner

    17. Negotiating the border: music therapy for people in the last hours of dementia

    Adrienne Freeman

    18. Can anything good be born of a dementia: potential for reparation?

    Jane Garner



    Sandra Evans has been an NHS psychiatrist, teacher and trainer for over 30 years. Sandra is a group analyst also in private practice with GANLondon.

    Jane Garner has over 30 years clinical experience in the NHS using psychodynamic ideas to inform psychiatric practice and teaching, particularly in the areas of old age and dementia services, continuing care, institutional abuse, sex and relationships.

    Rachel Darnley-Smith is a music therapist and senior lecturer at Roehampton University, UK. She has worked with people with dementia over many years, mostly in the NHS and published widely on music therapy, aesthetics and psychoanalysis .

    'This excellent book is a refreshing and valuable contribution to our understanding of the challenges faced by people with dementia and how we might help. By shining the different light of psychodynamics on dementia, the authors and the editors reveal novel insights and opportunities into dementia and how to improve the quality of care provided. The editors, Sandra Evans, Jane Garner and Rachel Darnley-Smith have done a fantastic job in commissioning and writing a set of chapters that will enable readers to challenge their assumptions and by doing so to think and act differently for the benefit of those with dementia.' – Sube Banerjee, Professor of Dementia and Deputy Dean, Brighton and Sussex Medical School

    'I would highly recommend this multi-authored book which brings a psychodynamic understanding to dementia care. This beautifully perceptive and insightful book helps the reader (both professional and lay) develop a greater understanding of the emotions encountered as the illness progresses.' – Amanda Thompsell, Old Age Psychiatrist at SLAM and Chair of the Faculty of Old Age Psychiatry at the Royal College of Psychiatrists

    'This is an essential and unique book which courageously explores the subjective world of dementia. So many find too terrifying to contemplate and yet with this book as a guide, clinicians, but also families and carers, will come closer to understanding how the world impacts on the mind of an individual suffering from this disease. It also helps with insights in relation to how the experience of dementia in someone close to them impacts on their experience of the world. This is an extraordinarily helpful and long-awaited book, which will be welcomed by professionals as well as those effected by this illness.' – Peter Fonagy, OBE, Professor of Contemporary of Psychoanalysis and Developmental Science, University College London

    'This unique, much needed book movingly and intelligently reflects upon the experience of people living with dementia and their families and carers through a new lens. Collectively, drawing upon psychodynamic and psychoanalytic theories; psychiatrists, analytic psychotherapists, psychologists, arts therapists and counsellors provide new meanings for those living with dementia, their families, carers and therapists. This rich multi-disciplinary perspective will appeal to professionals and family members and carers.' – Professor Helen Odell-Miller, OBE, Director, Cambridge Institute for Music Therapy, Anglia Ruskin University

    The book provides a strong argument for the value of a psychodynamic perspective for those affected by dementia. It challenges assumptions regarding who can benefit from a psychodynamic approach and encourages clinicians to always consider the emotional impacts of the disease, not only the person with dementia but for those around the person, including themselves. -Jodie Bloska; Cambridge Institute for Music Therapy Research, Anglia Ruskin University, UK

    This book is a must for anyone keen to support people who experience dementia at all stages, their family friends. It is an excellent book and one that I would highly recommend. - Kerry Jones

    Open University

    The essays in this book are very accessible and likely to be of interest to a wide readership of people who may be interested in dementia care. All of the contributors helpfully draw from psychodynamic theory without over-laying their essays too heavily with psychodynamic jargon. -Phil McEvoy, Anglian Community Enterprise, Salford, UK

    It certainly has a place on the bookshelf of a multidisciplinary professional working in this field.- Hugh Grant Peterkin, Homerton Psychological Medicine, East London NHS Foundation Trust, UK