CO-CREATING SAFETY

A therapist examines how to help some of the most at-risk psychiatric patients in this health care book.

This latest work from Frederickson dissects the nature of extreme vulnerability in patients, the factors that go into producing a particular delicacy in some people, and the added duties caregivers have toward this group. “Our task as therapists is to help the fragile patients recover their freedom to love, to live, and to create a life that matters,” the author writes. Therapists can complacently imagine that their patients are composed entirely of their histories, diagnoses, and genetics, but Frederickson stresses that this would be a mistake. If he and his fellow therapists do this, “we relate to dead concepts rather than living persons.” Instead, therapists must “mobilize the self-creative capacity to act.” The goal is not to steamroll patient anxiety in order to commence therapy but rather to create the feeling of personal safety necessary for healing. If the therapist rushes ahead without taking care to regulate the patient’s anxiety, Frederickson points out, the caregiver will become a source of danger rather than a fount of help. He makes a comparison with a shattered plate. No one would equate any of the broken pieces with the whole plate, and therapists need to differentiate between the symptoms of anxiety and the signs of the more severe “splitting” and “dissociation” that the condition often presages. The author uses an array of techniques in order to convey a large amount of complicated information: charts, graphs, anecdotes, dialogue examples, extensive secondary references, and bullet points fill the text. Frederickson’s tone is affirming throughout and always on the side of the patient. “No therapist should act as the captain,” he writes. “Our task is to help the patient become the skipper of her own ship.” The author’s fellow professionals will learn a great deal from these pages, but the layperson will find them very informative as well.

A smart, sympathetic, and detailed overview of the most vulnerable patients.