Abstract
This study examines the question of whether it is possible to enter into a psychotherapeutic relationship with a person diagnosed with dementia. A preliminary study focusing on providing short-term psychotherapy to a man diagnosed with severe dementia provided the opportunity to develop the case study approach used in this study, where the research design was constructed around an account of weekly meetings over three years. The term 'dementia' is explored along with the current treatments that are available and psychotherapy is considered in relation to them. Research is presented suggesting that education and learning might have an inhibitory effect on the onset and progression of dementia; psychotherapy is considered as a form of therapeutic education. The approach to the psychotherapy used in this study is explored, acknowledging the point that Freud highlighted with reference to psychoanalysis where he considered the technique to be individualised to each analyst rather than a generalised process. The therapist's orientation is examined by referring to the theory that has been instrumental in formulating his approach to psychotherapy which includes existential, psychoanalytic and post-modern theoretical perspectives on practice in relation to a person with dementia. From this exploration an approach based on the philosophy of Emmanuel Levinas emerges as the predominant influence in this study. The preliminary study highlighted the difficulties in using case study as a means of generating psychotherapeutic knowledge especially in relation to scientific methods of research. The researcher examined a range of epistemological ideas, including aspects of the work of Plato, Aristotle, Kant, Heidegger, in order to identify a basis for developing an approach to researching psychotherapy using a case study. A method emerged in the form of a psychotherapeutic case presentation from the therapist's perspective utilising a phenomenological-hermeneutic approach. This approach is concerned with producing 'meanings' in relation to an observation rather than being preoccupied with producing 'the' specific meaning. The case study is presented as an illustration of an account of a series of meetings between a trainee psychotherapist and a person diagnosed with dementia whereby the researcher and the reader can address the issue of 'possibility' raised by the research question. The findings of the study identify a difficulty for the therapist in this relationship to overcome preconceptions associated with the diagnosis of dementia. The account of therapy also shows how the therapist appears to be representative of other significant relationships for this person and acknowledges what Levinas calls the non-intentional which refers to glimpses of the other that allow a recognition of separation and 'otherness' that is not concerned with 'knowing'. The findings were also found to have significant implications for the use of intentional research and the potential influence that it can have on what is being observed by excluding the non-intentional. The association of theory with intentionality is identified in the findings and the possible impact on the practice of psychotherapy noted, particularly in relation to the prohibition of the non-intentional. The study concludes that the question of 'whether psychotherapy is possible' might be asked of anyone entering therapy. The diagnosis of dementia can have the effect of excluding a person from a relationship with another, and in these circumstances it becomes difficult to offer psychotherapy.