Psycho-analysis in the National Health Service General Hospital

SUMMARY

The paper describes the author's experience of practising psychotherapy based on psycho-analytic principles in three National Health Service Hospitals. Each is associated with a Post-Graduate institute. The Royal Marsden Hospital associated with the Institute of Oncology specialises in the treatment and study of cancer in all its forms in all ages. The Hammersmith Hospital is the site of the Royal Post-Graduate Medical School and it has an Obstetric and Gynaecology Unit which is part of the Institute of Obstetrics and Gynaecology. The Royal National Throat, Nose and Ear Hospital is a more compact specialist hospital associated with and containing the Institute of Laryngology and Otology.

In this paper instances are described where psychotherapy of Kleinian orientation has been helpful and has often been the only means of assisting patients by increasing their understanding and diminishing mental pain. The effects of introducing a psychotherapeutic rather than a psychiatric approach into the work of these departments is also described. The application of basic and fundamental analytic principles had a considerable advantage over the non-analytic psychological approach and was, in these circumstances, complementary to the one based on the medical/scientific model. This was particularly true of painful ‘terminal’ conditions. Liaison difficulties arise initially from the fact that medical and non-medical colleagues are commonly without experience of psychodynamic thinking and practice, and instead have many misconceptions about its nature and value. When the usefulness of the approach becomes evident to such colleagues prejudice gives way to understanding and co-operation. This has proved to be the most effective way of introducing analytically orientated psychotherapists and psycho-analytic thinking into the National Health Service, at the same time restoring to patients their dignity and supplying their needs as individuals for sensitive consideration and care.