Content uploaded by Gary Winship
Author content
All content in this area was uploaded by Gary Winship on May 11, 2016
Content may be subject to copyright.
14
Counselling and Psychotherapy in
Mental Health Nursing: Therapeutic
Encounters
GARY WINSHIP AND SALLY HARDY
Learning Objectives
●Understand the historical influences of counselling and psychotherapy to mental
health nursing practice.
●Consider the practical issues of engaging with counselling and psychotherapy
with acute adult mental health patients.
●Awareness of the processes and outcomes of engaging with counselling and
psychotherapy in mental health settings.
Introduction
This chapter provides an overview of how counselling and psychotherapy have
influenced mental health nursing practice. We aim to inspire a renewed curios-
ity about the influence of counselling and psychotherapy in contemporary mental
health nursing practice. The idea of interpersonal mental health nursing, as at the
heart of a therapeutic encounter, is considered in how words are spoken, received
and constructed during the relationship that develops between a nurse and patient
(Altschul, 1958; Cormack, 1976; Nolan, 1999; Peplau, 1952;). We outline how
a nurse seeks to develop therapeutic interaction through all aspects of his or her
14-Stickley & Wright_Ch-14.indd 223 30/04/2013 12:45:24 PM
THEORIES FOR MENTAL HEALTH NURSING
224
communication, whether verbal or non-verbal. Yet this can often feel like navi-
gating through an ‘unimaginable storm’ ( Jackson and Williams, 1994) as there
is a challenge when aiming to meaningfully engage with patients to help them
express their distress in words rather than actions. The nurse requires effective use
of words when confusion, hurt and rage often reign paramount in the people he or
she interacts with.
Talking therapy at its most potent is about expressing meaning, articulating
thoughts and emotions through a considered therapeutic encounter. A mental
health nurse might need to sit for hours with a suicidal patient, in a cold silence
that can become deafening; or be in a high secure hospital unit, listening intently to
ramblings of an index offenderwhere truth is seemingly dead in the woods. At other
times in outpatients with a detox-reluctant patient, where hope hangs as threadbare
as his clothes. In such situations, it may be words that find the therapist and not
the other way around. Where there is an urge to spit, scratch, smash, to embrace
ideas of dying, feeling dead and buried, or to be so furious, murderous with rage;
words found to utter, to clearly articulate such intensity of feeling, can bring relief
in contrast to immense distress that evokes a silence of inadequate words. Words
can become containers, filters and conduits that can ‘hold’ emotions (Rey, 1994),
giving them an outlet, a release, as if the pressure valve of internalised angst silently
screams for verbal expression: ‘speak to me please’ (Selima Hill: b.1945)
Counselling is something all nurses do?
Since the 1980s there has been a tradition of teaching Rogerian person-centred
principles in counselling training that has generally underpinned a humanistic
application of talking therapies across a range of mental health professions (Rogers,
1998). There are a number of broad interpersonal principles that all nurses are
introduced to in their education and probably try to adhere to in their daily practice
(Stein-Parbury, 1993). Even if the application of counselling and psychotherapy
principles are not clearly defined, they are for mental health nurses unanimously
applied. Burnard (1992) reports that all nurses counsel.
In the UK, the National Health Service is demanding as a workplace; physically,
psychologically and intellectually for any practitioner. To prepare practitioners with
information on a humane and well-meaning approach to the challenge of being
alongside patients in mental health care practice, without adequate consideration of
the powerful subversive influence of transference, counter-transference and result-
ant self-expression, is a recipe for disaster (Barnes, 1968; Bowers et al., 2010b).
14-Stickley & Wright_Ch-14.indd 224 30/04/2013 12:45:24 PM
COUNSELLING AND PSYCHOTHERAPY
225
Many nurses remain detached from their patients (Cohler and Shapiro, 1964;
Henderson, 2001; Menzies-Lyth, 1960; Moyle, 2003; Remshardt, 2012;] Winship,
1995), whether as a conscious or unconscious decision. Many have studied the psy-
chological impact of being ‘hit’ by a patient (Wykes and Whittington, 1991), with
the implications of workplace stress (Hardy et al., 1998) and need for effective
supervision as an ethical dimension of mental health nursing practice (Hardy and
Park, 1997; Milne and Reiser, 2012). Group therapy has become a key strategy
used in the toolkit of a mental health nurse, yet sufficient training for nurses run-
ning therapy groups remains poor (Burlingham et al., 2004; Garland et al., 2010;
Weisz et al., 2006). However, there is potential to reinvigorate interest and expecta-
tion around formal counselling and psychotherapy training, research evidence and
practice wisdom that can enhance the therapeutic environment (Mahoney et al.,
2012), patients’ level of engagement in their treatment (Hobbs, 2009), therapeutic
optimism/hope (Elsom and McCauley-Elsom, 2008) and well-being (Newnham
et al., 2010).
Historical developments
Active and exploratory psychotherapeutic approaches in mental health nursing
have been derived from the field of psychoanalysis, running deep foundations in
the formation of the modern profession of mental health nursing. Hildegard Peplau
(USA) and Annie Altschul (UK) from the 1950s developed an adapted psycho-
analytic procedure as a way of ensuring that mental health nurses could operate as
independent practitioners, applying the idea of talking therapy with novel possibili-
ties (Winship et al., 2009). There is much more that could be said about the com-
bination of feminism and anti-psychiatry that was refracted through the work of
Altschul and Peplau which not only pushed forward the establishment and author-
ity of mental health nursing in the latter part of the twentieth century, but also the
whole field of mental health. Derived in part from the radical libertarian ambitions
of psychoanalysis, not only as a means to therapeutic cure, but as a vehicle for social
reconstruction (Fromm, 1941, 1962; Marcuse, 1955), Altschul and Peplau learned
their trade under the wings of psychoanalysis (Winship et al., 2009).
There are notable parallels between the influence of Eileen Skellern (in the UK)
and Suzy Lego (in the USA), especially in shaping autonomous nursing practice,
with mental health nurses carrying clinical caseloads. Skellern worked in thera-
peutic communities (the Cassell and the Henderson clinics) informed by a com-
bination of psychoanalysis and social psychiatry. She had seen how politically alert
14-Stickley & Wright_Ch-14.indd 225 30/04/2013 12:45:24 PM
THEORIES FOR MENTAL HEALTH NURSING
226
therapeutic systems could enfranchise not only the patient, but also the staff. With
a therapeutic philosophy which challenged the hierarchical regimes of traditional
authority, Skellern and Lego were part of a wave of mental health nurses who were
able to reframe the patriarchal traditions of the medical model (Winship, 2008;
Winship et al., 2009). Skellern’s influence on UK government strategy in the 1970s
laid the foundations for annual nurse led awards and increased nurse autonomy
(www.skellern.info/index.html).
In the USA, Suzy Lego, having completed a further training as a psychoanalyst,
published numerous papers outlining the role of ‘one-to-one mental health nursing
practice’, defining a professional identity for the discipline of ‘nurse psychothera-
pist’ (Lego, 1974, 1987, 1993). As one of Peplau’s brightest students and a close
confidante, Suzy Lego carried forward Peplau’s vision for mental health nursing
into the 1980s and 1990s, advocating for a professional identity of a dually quali-
fied advanced mental health nurse who could enjoy parity with psychologists and
psychiatrists, whether in private practice or state institutions. Lego’s idea of inte-
grating the practice of psychotherapy and mental health nursing was embedded in
the journal Perspectives in Psychiatric Care, which carried the subtitle: ‘the Journal for
Nurse Psychotherapists’. The development in the role of nurse psychotherapists was
inspiring to a number of colleagues in the UK and though there were significant
problems with access to psychotherapy training outside London (McMahon, 1994
), still an increasing number of mental health nurses in the UK began to complete
formal analytical training, and for a time this resulted in a momentum to define the
role of nurse psychotherapists in the UK (Winship, 1996, 1998).
Lego’s death in 1999 (only a few months after Peplau’s) foreclosed what might
have been further significant contributions to a discourse on the role of the nurse
psychotherapist as an internationally regarded discipline. Mental health nursing
arguably remains the challenge of case management, control and restraint, medica-
tion adherence and so forth, where there may be less emphasis on the art of coun-
selling and psychotherapy. Even where there is general acceptance of the value of
talking therapy, the alliance between nursing and psychoanalysis, albeit with some
significant intellectual and institutional cornerstones, has been one that has rested
uneasily (Winship, 1995).
Rather than the more active ingredient of psychodynamic agency in mental
health nursing, the idea of psychotherapy has been generally applied in terms of
models of pastoral listening, reflection and befriending (Strang, 1981). Models of
recovery have also tended towards a frame of counselling as a friendly ear that can
support, advise and instil hope in clients on their journey to recovery (Repper and
14-Stickley & Wright_Ch-14.indd 226 30/04/2013 12:45:24 PM
COUNSELLING AND PSYCHOTHERAPY
227
Perkins, 2003). The rise of cognitive behavioural therapy has been identified as an
essential talking therapy in the discourse of mental health nursing with resultant
positive patient outcomes (Layard, 2006). Bowers et al. (2010b) assert that knowing
how to talk to patients is a necessary, everyday, core contingent in the process of
mental health nursing. The publication of the Social Exclusion Unit report Mental
Health and Social Exclusion (2004) reclaimed a socially orientated reconstruction
of mental health, but also the centrality of talking therapy. The report argued that
health services needed to be less medically driven and more socially focused in their
orientation; ‘more than 80% of GPs admitted over-prescribing anti-depressants
such as Prozac and Seroxat to patients suffering from depression, anxiety or stress’
(Social Exclusion Unit, 2004: 36). The report emphasised the importance of talk-
ing therapy as not only a viable alternative to pharmaceuticals, but as a first choice
intervention.
The fact that the UK government put aside money for the development of a
workforce of cognitive behavioural therapists demonstrated that the government
(Labour at the time) was to some extent willing to put its money where its rhetoric
was. However, the fit between CBT and social recovery might seem to be less viable
than other more socially focused counselling and psychotherapy approaches, such
as group therapy, interpersonal therapy or therapeutic community practice. CBT,
with a narrow individualist focus on mind and behaviour, might not vitalise the
relational dimensions of the therapeutic encounter that are the seeds of a recovery
process. Peplau’s (1952) first principle is that mental health nursing is essentially an
interpersonal process, and that the main agent of therapy is not a device, or a bio-
logical rebalancing act, nor is it derived from a manual that prescribes a particular
set of techniques that can correct the patient. Instead, Peplau asserts the main agent
of therapy is the nurses themselves.
Theory in practice
We learn to play with sound and forming words from the very start of life (Peddar,
2010; Winnicott, 1988). Although taken with the idea of psychotherapy as play,
many encounters in acute psychiatry with people deeply disturbed (as outlined pre-
viously) show that play is a long way from what is happening in the encounter. The
acutely disturbed or depressed patient may have lost capacity to play, or may not
have learned how to play at all. Instead, the therapeutic encounter can feel much
more like an altogether more backbreaking physical undertaking. The therapeutic
14-Stickley & Wright_Ch-14.indd 227 30/04/2013 12:45:24 PM
THEORIES FOR MENTAL HEALTH NURSING
228
alliance can be experienced as heavy duty. Counselling approaches for the men-
tal health nurse, at the sharp end of practice, may seem too passive, a game even.
Though the skills of listening are rightly credited, merely holding up a mirror and
reflecting back to patients (see the case example below) is not always enough to
bring about therapeutic gain.
A common mantra might be that words speak louder than actions for the ambi-
tion of all mental health practice. That is to say, helping patients find the words to
express their wish to self-harm or an urge to hurt others, or their need to express
what it feels like to be abused; these words might express feeling states that mean
future destructive acts can be lessened, more controlled, prevented even. Yet, a com-
mon concern for many nurses centres on not speaking of, or asking provocative
questions, or saying something that might provoke a violent reaction, encourage
delusions, persecutory thoughts, suicide even. Experience of working on an inpa-
tient unit has proven to me that continuous critical reflection, pertinent clinical
supervision and a willingness to feel, engage with and consider discomfort are all
important for the mental health nurse. The unit in question was influenced by
the psychodynamic psychotherapy principles of forming close working alliances
between nurse and patient ( Jackson and Crawley, 1992). We achieved this through
close supervision and a daily clinical evaluation system that incorporated all mem-
bers of the clinical team to come together to reflect and review their interpersonal
encounters. Learning from each other’s experiences enhanced the level of confi-
dence to express oneself within difficult and demanding situations.
I’ve lost my songbook
Patient:
I had a two hundred year songbook
Nurse:
Tell me about your songbook
Patient:
I don’t know where it is now – I lost it
Nurse:
That’s sad to hear
Patient:
My feet are bad today
Nurse:
What’s happening with your feet?
Patient:
My feet burn up, it’s when I did the test and walked on fire coals, I suffer
now and cannot get out of bed. I burnt my feet
Nurse:
Can you remember a time when your feet didn’t burn?
Patient:
I’m preparing to do an Arab-spring at school, I’m standing in front of a
room full of people, getting ready. I feel nervous, but do it, I get really
excited, there’s a tingle down my spine
Nurse
: What are you feeling now?
CASE EXAMPLE
14-Stickley & Wright_Ch-14.indd 228 30/04/2013 12:45:24 PM
COUNSELLING AND PSYCHOTHERAPY
229
Patient:
My Dad used to hit me when I was smaller, I never let out a scream, I just
kept quiet. Even at school I never showed things, even in prison I learnt
to bottle it all up inside.
Nurse:
Now the pain is coming out in your feet?
Patient:
I got the same excited feeling when robbing someone
Nurse:
Do you feel robbed of your past, having lost your songbook?
Can practitioners ever find the right words to soothe raw wounds like an oint-
ment or at other times, risk words that might cut deeply, like a surgeon’s scalpel?
Sometimes words need to be blunt, they can feel like using a mallet, resonating pain
without a physical touch. A patient spoke of wanting to throw himself in front of
a train, the nurse replied: ‘what about the driver, what about his family living with
him afterwards, could you do that to someone else’s children?’ The patient accused
the nurse of being insensitive. But he seemed literally stopped in his tracks, at least
for a moment. The words hit him, rather than the train. Words can also be sweet,
soothing or have to be swallowed, like a bitter pill. We all need to find the capacity
to speak out, find a voice, as clearly as we can. Of course there is a lineage here that
goes back to Freud’s development of the talking cure, from the moment that Anna
O discovered the idea that talking therapy is akin to chimney sweeping (Bruer and
Freud, 1895), where sense can be gleaned from experiences which otherwise seem
mad and incomprehensible.
Masson (1989) argued that a therapeutic encounter is only possible in a relation-
ship where there is no concern with power and hierarchy; yet for most, engaging
in a therapeutic relationship occurs between a patient and practitioner that will
initially offer a level of dependency on the therapist as carer/enabler. Breggin (1991)
recognised value in such a dependence, but qualified this by identifying the need for
consistency between the practitioner’s philosophy of care, and that of the patient.
Yet, there remain sizeable gaps in our knowledge about the finer tunings of talking
therapy. Bowers et al. (2010a, 2010b) completed a detailed analysis of the way in
which mental health nurses talk to acutely disturbed patients, showing that respect
and compassion are primary in the applied repertoire of the language of the nurses.
There is perhaps something unique in the everyday procedure of mental health
nursing in terms of the application of counselling and psychotherapy. Although
some nurses may indeed carry individual caseloads, and see clients for a traditional
sit-down face-to-face 50-minute therapy session, in mental health nursing prac-
tice there are otherwise manifold opportunities to apply counselling skills. Peplau
referred to this as the ‘other 23 hours’.
14-Stickley & Wright_Ch-14.indd 229 30/04/2013 12:45:24 PM
THEORIES FOR MENTAL HEALTH NURSING
230
As part of mental health nurse training at the Maudsley, during the 1980s to
1990s, a session was allocated where students could explore patients’ words, state-
ments, phrases that the student had found difficult to respond to, understand or
accept. For example, when patients said, ‘I don’t see the point of living’, or ‘my feet
are on fire’, finding the right words to respond in a therapeutic, engaged way –
rather than a more natural reaction of wanting to ignore, dismiss, laugh at or recoil
from – was considered central to a mental health nursing training experience. This
struggle to respond, reply, engage with the intensity of emotional distress is an
important part of the process required to understand and work alongside oth-
ers; understanding the chaos and uncertainty within which people exist. In fur-
ther developing educational approaches where practitioners can become versed in
therapeutic encounters, the use of experiential learning strategies whereby students
are exposed to therapeutic milieus (including free association in language and
articulation) is encouraged. For example, sessions where students develop narrative
group collages, where they might produce a collective sonnet/poem. In these ses-
sions students develop their own lines of thought around a particular topic before
cutting and pasting them together to form a longer collaboratively devised poem.
Students are encouraged to interrogate their own words, interactions, interconnec-
tions, reflecting on the nuances of their exchanges with patients, closely scrutinis-
ing the co-construction of meaning in verbal exchanges as part of the therapeutic
encounter between nurse and patient.
Conclusion
We advocate in this chapter for a revived interest in the importance of counsel-
ling and psychotherapy, as central theoretical principles in mental health nurses’
personal and professional advancemenrWe call for not just language acquisition as
a rational measure of competency in clinical practice, but the learning of fluency of
thought and accurate emotional reciprocity. This remains the challenge, where the
intensity of contact with a patient offers immeasurable opportunities to demon-
strate, through words, how nurses can reach the person, not just in the one-to-one
or group therapy sessions, but in all aspects of the ‘other 23 hours’. It is often said ‘a
picture can paint a thousand words’, but this overprivileges visual dexterity. Rather,
one word can paint a million pictures; some words like ‘love’ and ‘hate’ are infinite
in their complexity and meaning, experienced as different for each of us. When we
glance and gather words in our encounters with patients, the intricacies of meaning
suggest endless possibilities for therapeutic exploration.
14-Stickley & Wright_Ch-14.indd 230 30/04/2013 12:45:24 PM
COUNSELLING AND PSYCHOTHERAPY
231
Summary
This chapter has provided an overview of how counselling and psychotherapy has
influenced mental health nursing practice. We have aimed to inspire curiosity and
interest in the position and influence of counselling and psychotherapy in contem-
porary mental health nursing practice. Nursing models have drawn from principles of
counselling and psychotherapy in notions of interpersonal skills, therapeutic nurse–
patient relationships, and these remain at the heart of a therapeutic encounter.
We have outlined how a nurse seeks to develop therapeutic interaction through all
aspects of their communication. Yet there is a challenge when aiming to meaning-
fully engage with patients to help them express their distress in words rather than
actions. The nurse interested in the effective use of words can gain much from fur-
ther study, training and ongoing critical evaluation/supervision of the personal and
professional aspects of a therapeutic encounter. We would encourage continuous
curiosity into the infinite riches of counselling and psychotherapy for contemporary
mental health practice.
References
Altschul, A. (1957) Psychiatric Nursing. London: Ballière Tindall.
Barnes, E. (1968) Psychosocial Nursing: Studies from the Cassell Hopsital. Fakenham
Norfolk: Cox and Wyman Ltd. London: Tavistock.
Bowers, L., Brennan, G., Winship, G. and Theodoridou, C. (2010a) Talking with
Acutely Psychotic People: Communication Skills for Nurses and Others Spending Time
with People Who Are Very Mentally Ill. Monograph. London: City University.
Bowers, L., Brennan, G., Winship, G. and Theodoridou, C. (2010b) ‘How expert
nurses communicate with acutely psychotic patients’, Mental Health Practice, 13
(7): 24–6.
Breggin, P. (1991) Toxic Psychiatry: Why Therapy, Empathy and Love Must Replace
the Drugs, Electroshock and Biochemical Theories of the ‘New Psychiatry’. Glasgow:
HarperCollins.
Breuer, J. and Freud, S. (1895) ‘Fraulein Anna O.’, Studies on Hysteria, 21–47.
Burlingame, G.M., Fuhriman, A., Johnson, J. (2004) ‘Process and outcome in
group counseling and group psychotherapy’, in J.L. DeLucia-Waack, D.A.
Gerrity, C.R.Kalodner and M.T.Riva (eds), Handbook of Group Counseling and
Psychotherapy. Thousand Oaks, CA: Sage, pp. 49–61.
Burnard, P. (1992) Counselling: A Guide to Practice in Nursing. Oxford: Butterworth-
Heinemann.
14-Stickley & Wright_Ch-14.indd 231 30/04/2013 12:45:24 PM
THEORIES FOR MENTAL HEALTH NURSING
232
Cohler, J. and Shapiro, L. (1964) ‘Avoidance patterns in staff–patient interaction on
a chronic schizophrenic treatment ward’, Psychiatry, 27: 377–89.
Cormack, D. (1976) Psychiatric Nursing Observed. London: RCN Publications.
Elsom, S.J. and McCauley-Elsom, K.M. (2008) ‘Measuring therapeutic optimism’,
Australian and New Zealand Journal of Psychiatry, 42 (3): A51.
Fromm, E. (1941) Escape From Freedom. New York: Avon Books, 1965.
Fromm, E. (1962) Beyond the Chains of Illusion: My Encounter with Freud and Marx.
New York: Simon and Schuster.
Garland E L, Fredrickson, B., King, A.M., Johnson, D.P., Meyer, P.S. and Penn
D.L. (2010) ‘Upward spirals of positive emotions counter downward spiral of
negativity: insights from the broaden and build theory and affective neurosci-
ence on the treatment of emotional dysfunctions and deficits in psychotherapy’,
Clinical Psychology Review, 30: 849–864.
Hardy, S. and Park, A. (1997) ‘Supervision and professional practice’, in B. Thomas,
S. Hardy and P. Cutting (eds), Stuart and Sundeen’s Mental Health Nursing,
Principles and Practice. London: Mosby International.
Hardy, S., Carson, J. and Thomas, B. (1998) Occupational Stress: Personal and
Professional Approaches. London: Stanley Thornes.
Henderson, A. (2001) ‘Emotional labour and nursing: an under appreciated aspect
of caring work’, Nursing Inquiry, 8 (2): 130–8.
Hill, S. (1993) A Little Book of Meat. Newcastle: Bloodaxe Books.
Hobbs, J.L. (2009) ‘A dimensional analysis of patient-centred care’, Nursing Research,
58 (1): 52–62.
Jackson, M. and Cawley, R. (1992) ‘Psychodynamics and psychotherapy on an
acute psychiatric ward. The story of an experimental unit’,The British Journal of
Psychiatry, 160 (1): 41–50.
Jackson, M. and Williams, P. (1994) Unimaginable Storms: A Search for Meaning in
Psychosis. London: Karnac.
Layard, R. (2006) ‘The case for psychological treatment centres’, British Medical
Journal, 332 (7548): 1030–2.
Lego, S. (1974) ‘Nurse psychotherapists: how are we different?’, Perspectives in
Psychiatric Care, 11 (4): 144–7.
Lego, S. (1987) ‘The borderline patient: systemic versus psychoanalytic approach’,
Archives of Psychiatric Nursing, 1 (3): 172–82.
Lego, S. (1993) ‘Gratification and failure to separate’, Perspectives in Psychiatric Care,
29 (4): 25–30.
14-Stickley & Wright_Ch-14.indd 232 30/04/2013 12:45:24 PM
COUNSELLING AND PSYCHOTHERAPY
233
McMahon, B. (1994) ‘Professionalism and the development of psychotherapy’,
Mental Health Nursing, 14 (6): 14–17.
Mahoney, J.S., Paylo, G., Napier, G. and Giordano, J. (2012) ‘The therapeutic milieu
reconceptualized for the 21st century’, Archives of Psychiatric Nursing, 23 (6):
423–35.
Marcuse, H. (1955) Eros and Civilization. Boston: Beacon Press.
Masson, J. (1989) Against Therapy. London: William Collins and Sons.
Menzies Lyth, I. (1960) ‘Social systems as a defence against anxiety’, Human
Relations, 13: 95–121.
Milne, D. and Reiser, R.P. (2012) ‘A rationale for evidence based clinical supervi-
sion’, Journal of Contemporary Psychotherapy, 42 (3): 139–49.
Moyle, W. (2003) ‘Nurse–patient relationship: a dichotomy of expectation’,
International Journal of Mental Health Nursing, 12 (2): 103–9.
Newnham, E. A., and Page.E C (2010) ‘Bridging the gap between best evidence
and best practice in mental health’, Clinical Psychology Review, 30 (1): 127–142.
Nolan, P. (1999) ‘Annie Altschul’s legacy to 20th century British mental health
nursing’, Journal of Psychiatric and Mental Health Nursing, 6 (4): 267–72.
Peddar, J. (2010) Attachment and New Beginnings: Reflections on Psychoanalytic
Therapy: Reflections on Psychoanalytic Therapy. London: Karnac Books.
Peplau, H. (1952) Interpersonal Relations in Nursing. New York: G.P. Putman and
Sons.
Remshardht, M.A. (2012) Do You Know Your Professional Boundaries? Available at:
www.NursingMadeEasy.com (accessed on: 6/10/2012).
Repper, J. and Perkins, R. (2003) Social Inclusion and Recovery. London: Ballière
Tindall.
Rey, H. (1994) Universals of Psychoanalysis. London: Free Association Books.
Rogers, C.R. (1998) Client Centred Therapy. London: Constable and Robinson.
Social Exclusion Unit (2004) Mental Health and Social Exclusion. London: Office of
the Deputy Prime Minister, HMSO.
Strang, J. (1981) ‘Psychotherapy by nurses’, Advanced Journal of Nursing, 7 (2):
167–71.
Stein-Parbury, J. (1993) Patient and Person: Developing Interpersonal Skills in Nursing.
Edinburgh: Churchill Livingstone.
Weisz, J.R., McCarty, C.A., and Valeri, S.M.(2006) Effects of psychotherapy for
depression in children and adolescents:ameta-analysis’, Psychological Bulletin,
132 (1):132–149.
14-Stickley & Wright_Ch-14.indd 233 30/04/2013 12:45:24 PM
THEORIES FOR MENTAL HEALTH NURSING
234
Winnicott, D.W. (1988) Babies and their Mothers. London: Free Association Books.
Winship, G. (1995) ‘Nursing and psychoanalysis – uneasy alliances?’, Psychoanalytic
Psychotherapy, 9 (3): 289–99.
Winship, G. (1996) ‘Developing the role of the nurse psychotherapist in the United
Kingdom’, Perspectives in Psychiatric Care, 33 (1): 25–31.
Winship, G. (1998) ‘The nurse/therapist split’, Psychoanalytic Psychotherapy, 11 (3):
271–4.
Winship, G. (2008) ‘Therapeutic communities’, in P. Barker (ed.), The Art and Craft
of Caring. London: Hodder Arnold, Health Sciences.
Winship, G., Repper, J., Bray, J. and Hinshelwood, R.D. (2009) ‘Collective biog-
raphy and the legacy of Hildegard Peplau, Annie Altschul and Eileen Skellern;
the origins of mental health nursing and its relevance to the current crisis in
psychiatry’, Journal of Research in Nursing, 14 (6): 505–17.
Wykes, T. and Whittington, R. (1991) ‘Coping strategies used by staff following
assault by a patient: an exploratory study’, Work and Stress, 5 (1): 123–6.
14-Stickley & Wright_Ch-14.indd 234 30/04/2013 12:45:25 PM
