Unconscious communications

Raman Kapur

pp. 217-227

in: Ann Long (ed), Interaction for practice in community nursing, Basingstoke, Palgrave Macmillan, 1999

Abstract

Traditional models of communication within health care have relied mainly on learning theories whereby it is suggested that attention to overt and visible behaviours form the bedrock of therapeutic intervention (Hargie et al., 1993). The incorporation of cognitive psychology within clinical interventions has facilitated movement away from the purely behavioural responses to attending to cognitive processes. These "cognitive behavioural" interventions have recently been developed by Teasdale and Barnard (1993) where they take account of cognitive and affective processes. However, few models of communication have incorporated psychodynamic/ psychoanalytic perspectives into the everyday interactions that occur between community health care professionals and their clients. This chapter will outline some of the key concepts from psychoanalytic theory which will highlight interpersonal and intrapsychic processes that occur between nurse and patient. Unconscious processes such as transference, counter-transference and projection will be discussed and debated. An awareness of these hidden processes can offer community nurses a fuller picture of the patient's difficulties which can deepen their insight into how the patient is relating to him of herself and others. The chapter concludes with an example of a typical interaction between nurse and patient to illustrate the application of these concepts to practice.