Nidotherapy. Harmonising the Environment with the Patient By Peter Tyrer. RCPsych Publications. 2009. £10.00 (pb). 112pp. ISBN: 9781904671749

I have the privilege of working in a research-friendly service. As a result, my patients have benefited from a wide range of innovative therapies in their earliest stages of development. Some have flattered to deceive – compliance therapy comes to mind; some have prospered mightily – cognitive therapy for psychosis being an obvious example (though if Tyrer is to believed, this too may be due a re-evaluation); and some have had a hard grind to achieve recognition (cognitive rehabilitation is a good example).

I have yet to have any direct experience of nidotherapy, a coinage from the Latin that we are told means ‘nest’ therapy – though my Latin dictionary has the more evocative and perhaps appropriate word ‘haunt’ as the preferred translation. The ‘i’ is, by the way, long – as in ice-cream as opposed to nit. The question this short book begs is whether nidotherapy will move from its current niche (a cognate word, we are told), as a project based on particular enthusiasm, to more general application.

There is a deep humanity in this book, which begins with a rather moving prologue describing the interaction between Robert Cawley, a psychiatrist who was in my early years a slightly scary but very supportive professor, and Janet Frame, an author who had come very close to having a prefrontal leucotomy. Nidotherapy is, according to Tyrer, ‘a treatment born of despair and desperation’. Perhaps treatment is not quite the correct word, because the essence of nidotherapy, captured in the book's subtitle, is working with the patient to change their environment to make a better fit between them and their world.

Predictably, the book is clearly written, well-structured and gives a good account of what the aspiring nidotherapist might actually do, using clinical vignettes and exercises (the answers are provided in an appendix) to get the message home. Readers are taken through the four stages of nidotherapy: environmental analysis; making the nidotherapy pathway; initiating change; and long-term planning. Whether the intellectual argument for nidotherapy as a specifically new intervention is made is a moot point – the skilled mental health practitioner has always been working towards the aims Tyrer sets out and many have been more creative than the examples we are provided with.

Will nidotherapy move from niche to mainstream? My verdict is ‘possibly’ and I will be giving my copy to the newly appointed manager of a local service devoted to improving the ‘community opportunities’ of people currently stuck within our service.