The psychodynamics of the STD clinic: Secrecy, splitting and isolation

Abstract

We introduce the idea of a professionally isolated and apparently disconnected agency. We describe how health professionals working in settings with good multi-agency links may not recognize the effect of the isolated agency system on the presentation of problems. In particular, we describe the setting of the Sexually Transmitted Diseases clinic (STD) in which confidentiality can be turned into secrecy by the patients at the service of their denial of the seriousness of their problems. The isolation of the STD clinic as an agency resonates with the patients' isolation from their own feelings and emotional contact with people. It also isolates the professional and the therapeutic network. By way of clinical examples, we describe how this may deskill the staff and lead to dangerous situations.

Response to Chris Purnell's Article: An Attachment‐based Approach to Working With Clients Affected by Hiv and Aids

“…Avoiding the problem focus of counselling or therapy in this way could be a collusion with the client's denial of the pain he or she is in. I am reminded of a paper by Coleman and Etchegoyen (1992) which examines the powerful effect on staff of patients in a STD clinic. They noticed that alongside`the patients' insatiable demand for exclusive care' was the defensive denial of severe problems in relation to dependence and loss.…”