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This book is about the treatment of severely mentally ill patients and the supervision of the clinicians involved in this work. It focuses on adults but every child and adolescent psychotherapist I know has worked with this group in a direct or indirect way at some point as many of the parents or family members of children or adolescents in treatment have mental health problems. It should be essential reading for any psychotherapist wanting to understand more fully the potential contribution of psychoanalysis to all areas of mental health and it is perhaps especially useful in understanding the medical model (both strengths and weaknesses). Marcus Evans is well placed to explore this area having a background in psychiatric nursing before becoming a leading consultant psychoanalytic psychotherapist. Throughout the book Evans acknowledges his debt to many of the psychoanalytically oriented psychiatrists he encountered in his professional development.
The author sets himself an enormous challenge when he says he wants to ‘demonstrate the importance of the relationship between psychiatry and psychoanalytic psychotherapy in the treatment and care of patients’ (p. 203). Despite the contributions of leading psychoanalytic thinkers to psychosis over the last hundred years, the current hegemony in mental health services in the UK is arguably not amenable to the psychoanalytic model. The rise of manualised, time-limited and cost-oriented services have led to a shrinking of the space for thinking and a tendency to be blind to the psychological impact of this work on front-line staff. Evans makes a brave attempt to elucidate the potential for the relationship between psychiatry and psychoanalysis, stating, ‘… psychiatry needs psychoanalytic psychotherapy and psychoanalytic psychotherapy needs psychiatry’ (p. 203). I am tempted to say that he might have strayed into over-hopeful optimism that does not fit with my own professional experience.
It is important to state at the outset