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Severe illness has a profound effect on patients and their loved ones. When severe illness is stigmatizing, infectious, and ultimately fatal, the impact is devastating (Blendon and Donelan, 1988; Cohen, 1987, 1989, 1990, 1992; Cohen and Alfonso, 1998; Cohen and Weisman, 1986; Hunter, 1990; Kelly et al., 1987; Thompson, 1987; Wormser and Joline, 1989). At the same time, severe illness and awareness of mortality can be catalysts for change and can lead to conflict resolution. The catalytic effect of severe illness can be thought of as analogous to the impact of aging on psychodynamic psychotherapy. Some older individuals have a tendency toward reflection, reminiscence, and introspection. These characteristics combine with a sense of time urgency to energize the psychotherapeutic process. Some persons with AIDS are ideal candidates for psychotherapy for the same reasons. The setting of an AIDS nursing home provides a therapeutic holding environment enabling individuals to become aware of possibilities for change and rehabilitation.
Psychodynamic psychotherapy can be helpful to persons with AIDS in the nursing-home setting. It can help patients work toward healing and returning to the community, to adjust to severe disability, to resolve conflicts, to reunite with families or lost loved ones, or to resolve end-of-life issues and address existential anxiety prior to death.
A new 219-bed nursing home dedicated to compassionate and comprehensive care of persons with AIDS opened its doors on March 13, 1995. In the nearly 4 years since it opened, the changes in AIDS treatment have made radical differences in survival and quality of life with AIDS. The mortality has decreased and AIDS has become more of a severe chronic illness such as cancer. Nevertheless, the infectious nature of AIDS and the concomitant psychiatric disorders such as substance abuse and dementia, continue to complicate the picture. AIDSism (Cohen, 1989) and stigma are ongoing problems. The setting of an AIDS