About Adrian Sell

Why Isabel Menzies Lyth is More Important than Ever

As covered in my previous blog for Revaluing care OXPIP provide parent-infant therapy to people with babies from conception to age two. So why am I writing a blog which features someone who is famous for trying to understand the internal dynamics of hospitals and nursing? Isabel Menzies Lyth helped found the Tavistock Clinic but was most famous for her paper, ’Social Systems as a Defence Against Anxiety”. The paper studied trainee nurses and gave rise to concerns about how many nurses were failing to complete their training. She came to the belief that organisations working with trauma and illness developed defences to prevent front-line staff becoming overwhelmed by the distress and suffering they were experiencing on a day-to-day basis. I want to explain why I believe her thinking is still highly relevant to the provision of care and our work in Children’s Centres.

I will start with a bit more context about OXPIP and how we work.  We are one of the pioneers of parent-infant psychotherapy. We have been working in Oxfordshire for the last fifteen years looking at how to support the development of more positive early relationships between parents and their babies. Founded by Sue Gerhardt and others, and building on emerging knowledge about early brain development we now work with 300 families a year and consistently see improvements in maternal mental health and the quality of the parent-infant relationship.

What distinguishes the work of our therapists, aside from their considerable expertise and knowledge, is their focus on the relationship as the subject of therapy. Improving the relationship between a mother and her baby has benefits for both sides on every front from mental and physical health and wellbeing through to reduced criminality and better academic attainment later in life.

So, aside from being heavily influenced by Bowlby’s theories of attachment, how is Isabel’s work to better understand ‘institutional anxiety’ relevant to our work with parents and infants? The answer is that while our therapeutic work with parents and their babies is at the heart of what we do, there is a great deal around that which is also of value. We know from countless enquiries following tragic deaths that communication between professionals is critical to identify and respond to abuse and neglect. We also know, although it gets less prominence, that there is a natural human tendency not to think about horrific or unthinkable acts which are close to us, to not see that which should be apparent or not to act when rationally it is clear we should.

It is only through giving front line staff the time and space to think through the issues they are faced with that we can reasonably expect them to respond sensitively and appropriately. It is only by developing people’s understanding of human relationships and how to respond supportively to distress or dysfunction that we can hope to reduce the number of such tragedies.

Children’s Centres vary hugely and they include some highly skilled and experienced staff, but the jobs are often poorly paid and under-supported. We offer both formal supervision and informal consultation to staff in children’s centres which helps them to contain and understand the challenging emotions and behaviours they can be presented with on a daily basis.

For two years after leaving university I worked in front line care roles: an older people’s care home and a geriatric hospital. I have seen, and fought to resist, the institutional apathy and indifference which can so easily come to inhabit such places. Poorly paid staff, too many demands on their time, and little support from management will inevitably lead to people becoming numb and ignoring of the people in their care. I fought to resist it but for me it was a short-term job. Had I had to fulfil such a role for a living, for life, I would have struggled to retain my humanity and compassion for the people in my care.

It is this emotional exhaustion that leads to detachment and organisational anxiety. It is the need to acknowledge and address anxiety, despair and depersonalisation that makes the work of Isabel Menzies Lyth important. How do we ensure the health of the organisations that provide the care in our society? How do we care for the carers? How do we prevent organisations from sinking into malaise?

OXPIP: The Oxford Parent Infant Project
Suite J
High Street
The Kidlington Centre
Kidlington
OX5 2DL
T: 01865 371080 or 01865 778034
info@oxpip.org.uk
www.oxpip.org.uk

N.B. This blog is adapted from the introduction I gave for Jeremy Holmes when he gave the inaugural Isabel Menzies Lyth Lecture ‘Malaise in the NHS’ for OXPIP on 22 October 2013. For more information do drop me a line.

Care in the first two years of life: OXPIP and the emerging discipline of parent-infant psychotherapy

By Adrian Sell, Executive Director, OXPIP: The Oxford Parent Infant Project

OXPIP is one of the organisations pioneering parent-infant psychotherapy. Founded in 1998 we have been working in Oxfordshire to provide support to parents who are struggling to form a secure attachment to their baby. In the last three years we have worked with over 900 families and consistently improved mental health and the quality of the parent-infant relationship[1]. We work with babies up to the age of two and their parents, normally the mother but we have worked with many fathers as well.

Parent-infant psychotherapy is distinguished by the attention it brings to the mother’s mental health, the baby’s mental health and, crucially, to the quality of the relationship between parent and baby. This focus on the quality of the care that comes from this early experience is critical to our success in addressing intergenerational cycles of disadvantage. We all have a tendency to default to parenting our children as we were parented, even if those relationships were withdrawn, unpredictable or harmful.

Our clinicians are skilled at enabling parents to build and sustain closer relationships with their children. One of the therapeutic tools for achieving this is through modelling thoughtful, empathic ways of relating within the therapeutic relationship. For some of the parents we work with this is the first time they have really experienced being thought about and related to in this way; it can be a powerful tool for change, opening up new possibilities for how they in turn can relate to their babies.

Our team of psychotherapists come from a range of backgrounds including Child Psychotherapy, Adult Psychotherapy and Clinical Psychology as well as including prior qualifications in Health Visiting, Nursing, Midwifery, Social Work and Teaching. All have undergone Infant Observation training, and are trained in the use of video through the (NICE approved) Video Interaction Guidance approach. This mix of backgrounds and approaches gives our work a strength and rigour that forces us to constantly challenge our own preconceptions and viewpoints.

We are part of a growing national movement of people and organisations who are bringing greater focus to the first years of life. Our Executive Director, Adrian Sell is a trustee of PIP-UK a new national charity seeking to support similar services to develop elsewhere. We have backing from Impetus – The Private Equity Foundation where we are one of twenty-five organisations they see as critical social game-changers supporting disadvantaged children to develop to their full potential. We are a member of the Centre for Social Justice Alliance where we are recognised for our effectiveness in tackling the root causes of poverty and disadvantage. We are supporters of the All Party Parliamentary Group for Conception to Age 2 – the first 1001 days

We all instinctively know that the first few years of our life are formative. There is also considerable neuroscientific evidence that has emerged to support this. OXPIP are now at the forefront of developing an evidence base for the positive impact that parent-infant psychotherapy can have. If you want to find out more then please look at our website, get in touch or leave a comment below.

OXPIP: The Oxford Parent Infant Project
Suite J
The Kidlington Centre
Kidlington
OX5 2DL
T: 01865 371080 or 01865 778034
info@oxpip.org.uk
www.oxpip.org.uk