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This book offers an essential reminder of why it is of significant benefit to create and maintain space for psychanalytic thinking in mental health settings. As a psychiatric nurse and psychoanalyst, Evans is in a unique position to speak to the challenges exacerbated by ever-reducing resources in mental health provision. He explores how these challenges can be met, engaged with and transformed into meaningful communication in the minds of patients and staff by paying due attention to the unconscious processes at work. Readers well versed in psychoanalytic thinking will be familiar with the core theories Evans calls upon. Using these to underpin his thinking, Evans combines them with vignettes of clinical practice to illustrate why they are of benefit to multidisciplinary teams working in intensive settings. This style of mapping lends a persuasive air to each chapter, and there is a fine balance struck between theory and practice. Evans speaks clearly and succinctly, increasing access for professionals unfamiliar with psychoanalytic language and deftly illustrating how reflection in this way increases the capacity of staff teams and improves treatment outcomes. He shares the impact of how this process with auxiliary and AHP staff creates the potential for staff teams to think about the unthinkable, rather than unconsciously, and sometimes consciously, denying that which can feel overwhelming. Without attention and understanding, this process can lead to staff acting into a patient's pathology, leaving the patient disadvantaged and the staff member at a loss. This feeling of powerlessness accumulates over time, leading to desensitization and ‘burnout’, affecting overall provision due to sickness, low morale and the loss of valuable expertise.
Evans is clear at the outset when he says that mental health services are at ‘cross purposes’ with the patients when the goal is to move them towards a shared reality, rather than to understand each patient's reality (p. 1).