Academic journal article Perspectives in Psychiatric Care

Sibling Rivalry in Nursing and the Role of Nurse Psychotherapist

Academic journal article Perspectives in Psychiatric Care

Sibling Rivalry in Nursing and the Role of Nurse Psychotherapist

Article excerpt

TOPIC. The burgeoning role of the analytically prepared nurse psychotherapist in Great Britain.

PURPOSE. To describe the struggles of nurses in this role and ways this struggle might be lessened.

SOURCE. Observations of the author, an analytically prepared nurse psychotherapist-in-training in Great Britain.

CONCLUSIONS. The role of the nurse psychotherapist with psychoanalytic training is in its infancy in Great Britain. Barriers to the development are both external, from outside the nursing profession, and internal, in the form of sibling rivalry or envy from less prepared nurses. Increased communication among nurses is encouraged so that a shared understanding and mutual respect may result.

Key words: Countertransference, nurse psychotherapists, psychiatric nursing, psychoanalytic theory

A growing number of nurses in the United Kingdom are using psychoanalytic ideas in their work. Many have completed full psychotherapy training and seek to incorporate elements of both nursing and psychotherapy in their practices, referring to themselves as nurse psychotherapists. Others have undertaken specialist postregistration training in psychotherapy or psychoanalytic studies. The role of nurse psychotherapist is developing a distinct identity within the healthcare profession.

The ideas in this paper originate from a subtle but recurring perception that there is envy among less prepared nurses toward this group of entitled nurses, as well as rivalry among nurse psychotherapists over theoretical approaches. It is difficult to find precise examples or unequivocal evidence to support this hypothesis, which is founded on the impression made by the flavor of a conversation here, an observation there, and collected experiences assimilated over time. The intention is not to be didactic in the presentation of these developing thoughts, but rather to stimulate thinking and generate further ideas.

This paper is written from the perspective of work within the National Health Service, the current employer in some form or another of all U.K. nurse psychotherapists (Winship, 1997). The term "nurse psychotherapist" here refers primarily to those trained in and working from a psychoanalytic orientation.

The United Kingdom Healthcare System

The U.K. healthcare system is in a perpetually dynamic state, whereby a related spectrum of factors exerts varying demands (Figure 1).



Government policy and legislation over the last 15 years have directed the substantial strategic and philosophical changes that have occurred in the provision of mental health services. Arguably the greatest paradigm shift--from institutional to community care--has led to the closure of the majority of large hospitals in favor of smaller units. At an organizational level, this has contributed to a feeling of fragmentation among the groups involved.

There has been intense pressure from the public and the media for mental health legislation in response to a number of high-profile homicides and suicides, and recent focus has been on the specific targeting of services toward those with severe and enduring mental illness. The strong message is: resources are finite, some people's needs are greater than others', and there isn't enough for everybody to have an equal share.

Internal Market

For the moment, it is the role of the Health Authorities, who receive money from central government, to develop the detailed strategy for healthcare provision in local areas, taking into account government requirements, and to purchase services according to their plan. Hospital or community trusts have become the "provider units," whose task it is to provide health care within the specification of the purchaser.

Education, Experience, Research

Nurse training is surely the foundation on which the profession's future is built. …

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