Letter to the Editor

Dear Dr Milton

David Bell's (1997) paper in the last edition of Psychoanalytic Psychotherapy about in-patient psychotherapy at the Cassel is a further argument in favour of a demarcation between the roles of nurse and therapist in fostering the mutative processes in the treatment of patients in the psychotherapeutic treatment milieu. Bell's views concur with those expressed by Bob Hinshelwood and Sue Robinson (1996) in a letter to the journal last year in response to my review of the historical developments in psychoanalytically-oriented nursing . The triangular relationship between the nurse, therapist and patient in the Cassel therapeutic community, was well described previously by James (1984), and Bell's paper suggests that many of the same treatment contingencies are pertinent today.

The argument in favour of making a clear distinction between the role of nurse and that of psychotherapist is born out of a concern that nurses will cease to do nursing if they do psychotherapy. However, it is difficult to describe the work of some clinical nurse-specialists who work in psychotherapy services as anything other than psychotherapy. This dilemma has been one of the main talking-points at the first two APP nursing conferences, and was also discussed at the Institute of Psychoanalysis when a special evening was assigned to nursing. Contrary to Bob Hinshelwood and Sue Robinson's position on this, there is a great deal of impetus for less role-distinction. My feeling is that it is important to identify what is unique about the contribution of psychiatric nursing in the delivery of psychoanalytic psychotherapy in the public sector; at the moment those nurses with training as psychotherapists who are already working in the field of NHS psychotherapy have roles which are less easily identified. This is, I hope, a temporary confusional state, but it is one that is helpful insofar as it means that psychotherapy is being seen as less out-of-bounds for some nurses who are now begi