Life and Death

Andrew Balfour trained as a clinical psychologist at University College London and then as an adult psychotherapist at the Tavistock & Portman NHS Trust. He subsequently trained as a couple psychotherapist at Tavistock Relationships, where for more than 10 years he was Clinical Director before becoming Chief Executive in 2016.

“Psychoanalysis is about courage – courage to face distressing realities. Balfour’s book is a masterclass of discussing perhaps the most painful reality of all – the inevitability of time and with it our decline and ultimate ephemerality. This is a rare and immensely valuable contribution for clinicians and students facing an ageing population who turn to us in increasing numbers demanding and deserving psychological support. The book is rich with practical but remarkably gentle instruction on how this can be provided to the greatest benefit of both those asking for support and those who wish to offer it. This book, in addition to being scholarly and massively helpful, is above all, extraordinarily compassionate and equally empowering for therapists and clients. A major achievement of clinical skill from one of the major expert innovators in the field.”- Professor Peter Fonagy OBE FMedSci FBA FacSS, Professor of Psychoanalysis and Developmental Science, Head of the Division of Psychology and Language Sciences, Chief Executive, Anna Freud National Centre for Children & Families, University College London“This brave and moving book draws on the author’s long clinical engagement with both individuals and couples in their later years, facing the many losses of old age and the reality of death’s approach. Andrew Balfour’s scholarly grasp of psychoanalytic practice and its many theoretical roots is combined with a deep love of literature, especially poetry, and with solid knowledge of the contemporary conditions of old people’s lives and close and original study of the impact of dementia. It is a most impressive achievement, confronting readers with the painfulness of ageing but also with the human capacity to live in touch with our mortality if we can feel accompanied both within and without. It should be read very widely as our whole society needs to think afresh about how to create better lives and dignified deaths for old people.” - Margaret Rustin, Honorary Consultant Child and Adolescent Psychotherapist, Tavistock and Portman NHS Foundation Trust, Child Analyst, British Psychoanalytic Society“This beautiful book demonstrates the possibility of psychic development in spite of the extreme constraints of limited time. It exposes painful dilemmas for the therapist, yet the moving clinical work frequently involves repairing the apparently irreparable.” - Anne Alvarez, Consultant Child and Adolescent Psychotherapist“Ageing delivers gold mined from Andrew Balfour’s career-long study of older individuals and couples. Many clinicians shy away from this arena, but Balfour offers a dazzling array of clinical and theoretical pathways to understanding its travails alongside the possibilities for providing care for the aged. He brings his years of experience and his compassion to this examination of difficulties inherent in intimacy and sexuality, multiple physical and mental losses, family struggle, and the vicissitudes of dementia. This book unearths gems from the previously unexplored continent of ageing. For us clinicians who encounter ever more old individuals and couples, this book will serve as an inspiring guide.” - David E. Scharff, MD; Director Emeritus, International Psychotherapy Institute; Recipient, The Mary Sigourney Award for the Advancement of Psychoanalysis; co-editor, Psychoanalytic Couple Therapy“If, as Kafka said, the meaning of life is that it stops, this accessible book addresses unspoken fears and fantasies about loss of capacity, and the emotional challenges of later life. Drawing on vivid literary examples and a wealth of clinical experience, Andrew Balfour fosters both self-reflection and truthful communication in intimate relationships (even when one partner has dementia).” - Professor Joan Raphael-Leff, PhD [Retired], Fellow, British Psychoanalytical Society & Member IPA; Leader, Academic Faculty for Psychoanalytic Research, Anna Freud Centre London; Honorary Senior Research Fellow, UCL

• Introduction Chapter 1Ageing in Body and Mind: The Challenges of Living a Long LifeChapter 2Intimacy and Sexuality in Later LifeChapter 3Another Country? Migration, Displacement, and Internal Dislocation in Old AgeChapter 4How to Think about the Experience of Dementia? The Importance of the Unconscious MindChapter 5The Fragile Thread of Connection: Living as a Couple with DementiaChapter 6Working Psychotherapeutically with Couples who are Living with DementiaChapter 7At Home in a Home? Institutional Care and the ‘Unheimlich’Chapter 8Dying and Assisted Death