Psychodynamic Approaches to the Experience of Dementia: Perspectives from Observation, Theory and Practice Edited by Sandra Evans, Jane Garner and Rachel Darnley-Smith Routledge. 2020. £26.99 (pb). 268 pp. ISBN 9780415786652

It is just over 5 years since dementia overtook cancer as the most feared condition in the UK; it is unlikely that they will change places in the foreseeable future. This wide-ranging, innovative and engaging book explores that fear, alongside the many other responses generated in patients, carers and healthcare professionals when encountering dementia.

Consisting of 18 discrete chapters, the book draws together a diverse range of experts and approaches. It covers different therapeutic modalities (including individual, couple, music and group), different psychodynamic theories (attachment theory proves particularly useful in looking at issues of trust and dependence) and different settings (psychiatric wards, care homes and patients’ homes). It also moves across the whole journey of dementia, from diagnosis, to mild impairment, to more advanced dementia to death. Although the editors are London based there is a global reach too, with some authors writing about their experience in New Zealand. Given this diversity, it is surprising that the book feels as coherent as it does. Stylistically that coherence derives from the use of case studies throughout; this ensures that chapter authors move from observation to theory to practice in a way that feels informative and authentic. The second uniting factor for all the authors is their ability, while acknowledging the huge psychological challenges facing someone with dementia, to retain hope: a hope based in the value of emotional contact to change how someone with dementia feels about themselves and the world.

There may be some scepticism about bringing psychodynamic thinking to bear on dementia, but it proves insightful across many domains. Of particular interest are the responses of healthcare professionals: the potential drift towards objectifying and infantalising people with dementia, the use of task orientation and humour as defence mechanisms and, importantly, the need to recognise and move beyond these responses in order to act as containing entities for carers, who can in turn contain the emotional states of the person with dementia. The movement from psychoanalytic theory to the quotidian aspects of care and back again also means that the concepts described have direct bearing on clinical work: for example the idea of ‘mature interdependence’ rather than ‘independence’ as a therapeutic aim, the concept of ‘moment to moment competency’ in relation to difficult emotional states (in oneself and others) and the idea that challenging behaviour should be seen as something that we (professionals) are challenged by, not as something that is inherently challenging.

A drawback of the book is that the wide range of topics and authors mean it can become overwhelming. It is therefore best read as separate chapters, ideally in response to a clinical or personal situation. Given how much the book does cover, it is churlish to talk of omissions, but it would be interesting to see gender and race given more space and professionals as patients considered in a second edition. In terms of complexity it probably sits above the average undergraduate, but it is certainly pitched at a level appropriate to healthcare professionals working in this field, as well as carers and some people in the early stages of dementia. It certainly has a place on the bookshelf of a multidisciplinary professional working in this field. Interestingly, there is also much in the book that is transferable to work in adult psychiatry, particularly rehabilitation psychiatry.