The emotional labour of work with people in pain and distress will inevitably create institutionalis

1

• The emotional labour of work with people in pain
  and distress will inevitably create
  institutionalisation and defensive practice
  unless conscious measures are taken to create
  space for staff to consider the functioning of
  the organisation and the implications of the
  defence mechanisms evoked.

2
Defences

• Users become non-human
• Emotional involvement avoided
• Care process divided into fragments so that each
  practitioner is responsible for only one function

3
Implications

• No one person gets to know the whole person.
• No effective relationships- the bedrock of
  effective provision feelings of isolation and
  not being understood (also risk)
• A less emotionally satisfying and more
  meaningless work experience for staff

4
Need for Containment (after Bion, 1962)

• Like a good enough mother the organisation
  needs to be able to take in the distress of
  painful experiences and work with it in a way
  that allows it be returned as understood and
  relieved.

5
Need for Containment (after Bion, 1962)

• Without containment, there is the risk that
  staff talent is wasted, staff health both mental
  and physical is put at risk and the institution
  becomes ossified, focusing on the accretion of
  further layers of defence mechanism rather than
  retaining the flexibility needed to survive in an
  ever-changing world (Obholzer, 2005, p300).

6
Where things go wrong in teams

• in times of stress disciplines and individuals
  become defended islands in a melee of splitting
  and projection.
• the rhetoric of professional self-management and
  autonomy invoked
• retreat into individual management structures,
  each managed by their own hierarchy somewhere
  else.

7
Where things go wrong in teams

• Doctors cannot manage nurses, or the other way
  round, social workers are accountable elsewhere
  and so it goes on like the childrens playground
  game where, when things become threatening, one
  can say paxi you cant touch me.

8
Where things go wrong in teams

• Individuals of particular disciplines come to
  feel that they know better than another
  discipline how a user should be worked with
• Obholzer Knowing better is, by and large, a
  flight from ones own individual and professional
  sense of inadequacy or impotence .and easy to
  maintain if one does not have the chance to put
  ones supposedly superior ideas to the test
  (302).

9
Where things go wrong in teams

• The test can be avoided because people do not
  proffer ideas knowing that to do so would cause
  offence to other disciplines.
• RESULT Ideas are not shared ? depression,
  paralysis and loss of agency.

10
Projections outside the team

• a why doesnt somebody do something state of
  expectation
• a flight from the position that progress could be
  achieved if people contributed what they were
  able to contribute to the process of improvement.
  
• Where staff become accustomed to referring
  decisions up the chain of command, and assume no
  real responsibility, there is no sense of
  ownership of the task of improvement.