Letter to the Editor

Dear Dr Milton

We would be grateful for a small amount of space to respond to Gary Winship's excellent article on psychoanalysis and nursing. But there is a significant omission in his impressively clear digestion of the literature in Britain and in North America.

We would want to emphasise that the proper relationship is the application of psychoanalysis to nursing. Readers of Gary Winship's paper could be left with the view that he is advocating the practice of psychoanalysis by nurses with their in-patient charges. This impression could be gained from his emphasis on, and quotations from, the work of Peplau.

The practice of psychoanalysis (and of psychoanalytic psychotherapy) is through the medium of words in a very circumscribed setting. The practice of nursing is one of activity in a daily living setting. This distinction needs to be sustained. Nurse-counselling on a ward could be informed by psychoanalysis, but it is the practice of neither psychoanalysis nor of nursing. In our view, the challenge that is implicit in Gary Winship's title (Uneasy Alliances?) is to apply the ideas gained from a verbal practice (psychoanalysis) to one based on activity (nursing). This is both a conceptual challenge and a practical one.

In a psychoanalytic setting, more or less all activity contravenes the golden rule, and is therefore deemed, rightly, to be acting-out. In an everyday setting, on the other hand, activity is deeply embedded in the relationships and in the very life of the setting itself. The challenge to psychoanalysis is to conceptualise ordinary activity in an everyday setting as distinct from acting-out. The challenge to nursing is how to make activity with patients as telling a therapeutic modality as verbal interpretation. It needs to be a psycho-social practice.

We were very pleased with Gary Winship's generous comments about the Cassel Hospital's ‘contributions to psychoanalytically-informed nursing’ and our own role in developing this. It seems important to regi