A psychoanalytic investigation of transference management in the Irish adult public mental health services
Moore, Gerard (2012) A psychoanalytic investigation of transference management in the Irish adult public mental health services. PhD thesis, Dublin City University.
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Mental health is a pressing issue for society with approximately 700,000 of the Irish population being affected by a mental health problem over the course of their lives. Despite the extensive demand and the national reformation agenda recent reports indicate that patients are unsatisfied and readmission rates remain consistently high indicating that services do not enable recovery.
Psychoanalysis has demonstrated that to enable positive change it is essential to manage transference. Transference is experienced in the immediate reactions of liking or disliking influential Others; often the subject who we suppose has knowledge that will benefit us. In services this Other is usually the health care professional. Managing transference requires a connection between consciously expressed expectations and unconscious desire. Health care delivery takes place within a therapeutic professional relationship placing responsibility on staff to acknowledge and address the quality of the relationships they have with service users.
The reviews of service user satisfaction and the consistent readmission rates indicate that health care professionals are unskilled at forming positive therapeutic relationships. The aim of this study is to investigate the current management of transference and to make recommendation in relation to how recognition and management of transference may have positive outcomes for service users and providers.
Following a review of relevant literature, a qualitative methodology was designed and data collected by interviews and non-participant observation in an acute mental health service. The data were analysed with a Freudian/Lacanian theory of the subject. Findings were grouped under four formulations, transference, language, groups and leaders and resulted in a set of recommendations.
Key findings indicated that the act of caring provokes overwhelming anxiety in staff resulting in the patient being viewed as an object rather than a subject. Transference is unacknowledged and unmanaged and emerges in a negative form which contributes to the mismanagement of critical incidents. Staff are more concerned about maintaining the system that engaging with patients. Some professional groups lack language to describe their work resulting in the retention of patients as minors. Staff speak for rather than with patients. However with appropriate interventions for staff such as psychoanalytically informed supervision alongside a shift to a post-modern philosophy of care positive change could be achieved.
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