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Words are Ways
(2009)
John Klauber's introduction of the concept of >encounter< signifies a milestone on the way towards an intersubjective understanding of the psychoanalytic method. The concept of encounter is comprehensive and refers to all aspects of the >here-and-now,< including transference from the >then-and-there.< Klauber's contribution points out that the psychoanalytic situation is primarily a therapeutic one. The solution to the transference depends on new experience, and therefore he emphasizes the role of spontaneity. Klauber describes unintended traumatizing aspects, one of the antidotes for which is spontaneity. What is real and actual in the transference should be admitted – at least as >plausible.<
Theoretical and clinical concepts of psychoanalysis are presented here in terms of their relevance for forensic psychotherapy. They can be applied to individual psychotherapy, special nursing care, and the theory and practice of a therapeutic community. Essential concepts of seduction and traumatisation are presented in the language of drive psychology, as well as in the modern terms of self psychology and object relations theory. The criminal act forms the basis of forensic psychotherapy, the aim of which is to prevent a repetition of this or a similar act. This means that a certain type of act, namely a criminal act, lies at the heart of not only forensic psychotherapy, but also the concept of action itself. Psychoanalytic concepts stress the unconscious processes around and after the act. These processes are repeated in the everyday life of the therapeutic community and in the specific psychotherapeutic situations. Empiric evaluations are methodologically very difficult, as they must investigate multiprofessional settings.
The aim of this paper is to clarify some important interpersonal dynamics that underpin forensic patients’ presentations within the clinical environment, in a way that is accessible to nurses. The world of forensic mental health nursing is often difficult to describe to those who have not experienced first hand prolonged clinical contact with patients at the therapeutic interface of secure services. Even then, the characteristic, intense emotional phenomena that tend to arise out of interpersonal relationships with patients and colleagues is not easy to articulate. Yet, for those of us who consider our professional identity to be one of >forensic mental health nurse,< it seems important to find a way to put words to what appears to occupy a large component of our working lives. More importantly, if we can develop a way to make sense of the way our work makes us feel and the way we can find ourselves relating to others within our professional roles, we will be in a better position to harness our energy and enthusiasm in the service of supporting forensic patients towards effective care and treatment pathways. Of course, forensic patients are supported through services with or without a framework for articulating emotional and interpersonal experiences. However, this frequently occurs in the context of significant struggle. For patients, this struggle is often characterized by difficulty communicating what their needs are, and for nurses this struggle is often characterized by feeling emotionally overwhelmed by their task of providing containing, therapeutic relationships for patients whose interpersonal needs are not clear to them. This article will use case examples to describe some of the complex interpersonal and emotional challenges faced by forensic nurses, and explain how a psychodynamic framework could support nursing practice in each of the case examples.