Promoting excellence in community nursing across Scotland
Applying a Psychodynamic Approach in Primary Care
Dr Sarah Doyle (Deputy Nurse Director, QNIS)
As a community nurse in primary care, how often do you spend time with someone who worries you, and then struggle afterwards to put into words why you felt that way? Or find it difficult to stop thinking about someone whose story stays with you long after they’ve left the appointment?
What do you do when you feel overwhelmed by the tragedy in someone’s life? Or when you can’t seem to engage someone, no matter how often you try? When each time you speak with someone, they say they want you to help but then don’t attend the next three appointments you offer?
How do you connect with someone who ignores your regular calls but then presents in crisis every other month? Or someone who keeps putting themselves at risk?
How do you react when someone you’re trying to support makes you feel unsettled or even annoyed in some way? Or when the person in front of you becomes hostile no matter how hard you try to convey care and concern?
Each of these instances is worth exploring from a relationally informed perspective because each one is very likely to have at least some roots in relational issues. Even behaviour that seems to make no sense initially, can turn out to be a perfectly understandable consequence of traumatic early experiences and continuing adversity. But it takes a special kind of attention, patience, and consistently reflective curiosity to tune in and then respond to these interpersonal dynamics.
Applying a psychodynamic approach means taking account of, and caring for, the different emotional states of mind that frequently accompany and influence behaviour we might otherwise find difficult to understand. A psychodynamic approach also promotes and supports a willingness to engage with and consider our own discomfort, so that we can pause and think more clearly before we act. This thoughtful pause can help prevent us from becoming, for example, debilitated, desensitised, or disillusioned – or even just help us recognise when these feelings might be colouring our professional interactions. Otherwise, we are much more likely to respond defensively. And in turn, our defensiveness risks further alienating people already marginalised and excluded.
The more we recognise the impact of adversity, the more we must adapt our clinical practice and the organisation of services to allow for the ambivalence felt by traumatised people when accessing healthcare. We shouldn’t give up after a few missed appointments or insist on time-limited treatments when we know that trauma can make it difficult to trust (Hawthorne and Burley, 2020). If you are interested in learning more, you can apply for our programme of workshops here.Reference
Hawthorne, J. and Burley, A. (2020) Leaving Lockdown: Moana, trauma and voyages of discovery.
Clinical Psychology Forum, 332, pp. 12 – 16.