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 3 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 may 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 approach to researching psychotherapy using 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 ‘meaning’s 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 this 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 internationality 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.

Based on the above findings, the researcher has the following suggestions: (1) The use of therapeutic settings and therapeutic relationships in working with clients should be strengthened in education and continuous professional training for Chinese psychotherapists, especially to those who do not have educational background in medical science. Simultaneously, it is important to enhance the reflectivity of Chinese psychotherapists on their work and life experience. (2) To emphasize the legitimacy of psychotherapy in China, we have to regulate the norms of the profession according to the professional Code. Further, the principle of "do no harm" should be given higher priority in psychotherapy, psychotherapist need to cope with the demands from reality using wisdom and reason, pay attention to the affective needs of clients and promote social justice. (3) In the development of psychotherapy in mainland China, special efforts should be made to preserve the positive elements in traditional Chinese culture for the helping professions, keeping a balance between technical rationality and humane concern. We should pay attention to the goals of enhancing individual development, respect for diversity and importance of equality in practice as well as utilize the Chinese tradition and culture in helping clients to develop compassion, having empathetic understanding on the needs of one another. The purpose of doing so is to develop a new culture valuing compassion and reason in relating to one another. / The major findings of this research are as follows. (1) The understanding on the role of the therapeutic settings by the therapists are different. In comparison, those with training in psychoanalysis tend to attach more importance on the role of therapeutic settings than those who do not have such training. (2) The mainland psychotherapists still emphasis the importance of affection in relating with clients, using special rather than standard treatment for particular clients, which may result from the "differential distance in interpersonal relationship" dominant in Chinese culture. (3) Professional ethics for communities of counseling practice is newly introduced into mainland China, and people are beginning to pay attention to its relevant ethics. Its development, however, is still in infancy stage. (4) The mainland Chinese psychotherapists emphasis more on building relationship with people than developing technical skills in psychotherapy. This may be related to the fact that Chinese culture attaches more importance to interpersonal relationships. / This research attempts to answer the following questions: (1) What are the understanding of mainland Chinese psychotherapists about the meaning of professional ethics and therapeutic relationships? (2) How do they establish therapeutic relationships with their clients? (3) Are there any patterns in their establishment of therapeutic relationships, and how they interpret these patterns? (4) In their views, what are the principles and main points in establishing a healthy therapeutic relationship? / This study has implications for the helping professions in mainland China that it reveals the experiences, feelings and cognition of some mainland Chinese psychotherapists in their embodied professional ethical norms and therapeutic relationships. It illustrates the characteristics of these psychotherapists in dealing with professional relationships in a country which still values relationships and human feelings. The study also examines the factors that have influenced these psychotherapists in the development of their characteristics, e.g. the country's history, modern cultural atmosphere, and the ordinary people's routine styles of interpersonal exchange in China. The findings of this study, as a preliminary exploration of the process of establishing ethical norms and principles in mainland China, would be helpful to the development of social work in mainland China. (Abstract shortened by UMI.) / This study is significant as it is the first qualitative inquiry of the therapeutic relationships between clients and psychotherapists in mainland China. It explores the the impact of Chinese cultural tradition and modern social development on the mentality of mainland Chinese psychotherapists. / Using social constructivism as the epistemological frame, ecological systems theory is chosen as the theoretical framework in conducting the study using qualitative research. In-depth interviews and on-site observations are the methods chosen to collect data. The main source of data comes from in-depth interviews with 15 psychotherapists in different institutes located in four cities in mainland China. Through careful analysis of the data, thick description is used to describe the data. And using thematic analysis for the interpretation of the findings. / 陳向一. / Source: Dissertation Abstracts International, Volume: 71-01, Section: A, page: 0332. / Thesis (doctoral)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (p. 277-300). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Chen Xiangyi.