2014; Volume 15, No 2, February
IAHPC book reviews
By Dr. Roger Woodruff
Palliative Care book of the month
WHEN PROFESSIONALS WEEP
Emotional and countertransference responses in end-of-life care
Renee Katz and Therese Johnson (eds)
Routledge, 2006
303 pp
ISBN 978-0-415-95095-3
RRP $US 44.95, £ 24.99
A word of orientation is perhaps in order. Countertransference was originally described by Sigmund Freud as an unconscious process involving the arousal of the analyst’s unresolved conflicts and problems, which was regarded as an obstacle to treatment. But now, I am told, the definition has been extended to include the totality of feelings experienced by the clinician toward the patient, whether conscious or unconscious, and whether prompted by the patient’s situation or by issues in the clinician’s own life. Understanding these reactions and using them in a therapeutic context can be of significant benefit in end-of-life care.
In this book, a range of health care professionals working in end-of-life care address the issues surrounding the intersection of the personal and the professional in the unique context of their work. There are chapters on different aspects of suffering, different clinical situations, different patient populations. I liked the chapter by Kelly and Varghese on The Seduction of Autonomy which describes the main question that needs an answer in cases of physician-assisted suicide to be “is the patient competent?”, rather than the need to explore the complex issues involved in such a request, the patient’s experience of their illness, and indeed the clinician’s own experience of illness.
For anyone who works in palliative care, there is a lot to think about here. Situations and treatments are described that end well, some badly; I recognized some of both. To quote Johnson, “There are no easy answers. There are guidelines, rules and regulations, fate and circumstance, that point the way. Our responsibility is to remain conscious of all the forces that determine our actions. If we are not conscious of our beliefs and judgements that give rise to our countertransference, we will unknowingly make or participate in decisions influenced by these biases, often harming our patients and ourselves.” The other thing that struck me was the importance of recognising our own opinions and feelings (called countertransference in this book) in “being there” with patients.
Other reviews
FACING CANCER AND THE FEAR OF DEATH
A psychoanalytic perspective on treatment
Norman Straker (ed)
Jason Aronson, 2013
156 pp
ISBN 978-0-7657-0965-3
RRP $US 70.00, £ 37.95
Dr. Norman Straker is a psychoanalyst who has worked for many years at the Memorial Sloane Kettering Cancer Center in New York. The main goal of this book is to recognize the important role that ‘death anxiety’ plays in all aspects of health care and to explore what remedies might be considered. If doctors, mental health professionals, patients, their families, hospital administrators, and policy makers can be helped to face death with less anxiety and apprehension, it may lead to great improvements in the quality of care and the patients’ quality of life. It may also help contain the escalating, and ultimately unaffordable, costs of continuing what is essentially futile therapy in patients who are dying. The literature is reviewed and there are a number of case reports and memoirs by psychoanalysts detailing the difficulties of dealing with patients who are dying and a couple of stories about dealing with their own cancers.
A second goal is to help psychoanalysts become more at ease with the concept of death anxiety and treating dying patients, and recruiting them to bring their knowledge of unconscious conflict to the hospital where they can help their medical colleagues with the complexities of end-of-life issues.
The issues dealt with in this book are topical and real. It was interesting to read about the psychological needs in end-of-life care from a slightly different angle (i.e. by psychoanalysts), and the potential benefits of palliative care as viewed from outside our speciality.
FAST FACTS FOR THE GERONTOLOGY NURSE
A nursing care guide in a nutshell
Charlotte Eliopoulos
Springer Publishing, 2014
381 pp
ISBN 978-0-82619827-3
RRP $US 30.00, £ 18.12
This book sets out to provide gerontology nurses with the foundational knowledge they need to provide safe, effective care to older patients in all care settings. It contains a lot of information and is well set-out. There are lots of bullet-point lists and the text is enhanced by “Fast facts in a nutshell” boxes. The problem with this type of book is where do you draw the line regarding detail (what do you include and what do you leave out) and explanation (many facts are not black and white and deserve some explanation or qualification).
Many patients seen by palliative care services are older adults and there is a good case for having a gerontological text available for occasional reference. This book provides a good frame of reference for managing older patients that would be useful to anyone training in palliative care, but I think it lacks the medical detail to make it useful as a day-to-day reference.
Roger Woodruff, MD (Australia)
January 2013
Dr. Woodruff is a Lifetime Member of the IAHPC Board and Past Chair. His bio may be found here.
Note for authors and publishers: If you wish to have your book reviewed, please send to:
Dr Roger Woodruff
IAHPC Bookshop Editor
210 Burgundy St, Suite 9
Heidelberg, Victoria 3084
AUSTRALIA
Note: Review copies become property of IAHPC and are not returned to the author. Only palliative care related books which are previously approved will be reviewed. Due to the large number of requests, we can't provide exact dates of when books will be reviewed.
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